National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery

Objectives: To assess the individual impact of social determinants of health disparities (SDHD) on surgical outcomes following orthopaedic trauma surgery.

Design: Retrospective Cohort Study.

Setting: Mariner Claims Database.

Patients: Inclusion criteria were patients 18-85 years of age, undergoing surgery for hip fractures or ankle fractures from 2010 to 2018.

Intervention: Patients were divided based on SDHD using International Classification of Diseases 9 and International Classification of Diseases 10 codes. Those with SDHD were propensity-score matched with those who did not have any disparities with respect to age, gender, Charlson comorbidity index, tobacco use, and obesity (body mass index >30 kg/m2).

Outcomes: Ninety-day major medical complications, infection, readmission, and revisions within 1 year.

Results: Patients with educational deficiencies had increased rates of readmission and major complications compared with those without disparities following hip and ankle fracture management. Moreover, economic disparities were associated with an increased risk of readmission and revision following hip fracture surgery and infection and readmission following ankle fracture surgery.

Discussion/conclusions: This study emphasizes the large impact of SDHD on patients' outcomes following surgery and the importance of proper follow-up interventions to optimize patient care.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.