Does Time to Imaging and Surgery for Distal Radius Fractures Vary based on Geographic Socioeconomic Disadvantage?

Abstract

Background: While disparities in aspects of distal radius fracture (DRF) management and orthopedics at large have been studied, disparities in time to DRF evaluation and treatment are unknown. We sought to determine if geographic socioeconomic disadvantage is associated with time to imaging in the emergency department (ED) and time to surgery for DRFs. Methods: We performed a time-to-event analysis of 105 patients undergoing DRF surgery after ED triage within our hospital system between January 1, 2015, and January 1, 2020. Area Deprivation Index (ADI) national percentile was used as the metric of geographic socioeconomic disadvantage for each patient’s ZIP code of residence. We performed Cox regression analysis to determine hazard ratios to undergo DRF imaging and surgery for patients in each ADI group, adjusting for potential confounders, α = 0.05. Results: There was no association between geographic socioeconomic disadvantage and time to DRF imaging, after adjusting for confounders. However, compared to patients from the least disadvantaged areas, patients from the most disadvantaged areas (ADI Quartiles 3 and 4) had an adjusted hazard ratio for surgery of 0.55 [0.32, 0.94] ( P = .03), and were thus 45% [6%, 68%] less likely to undergo surgery for DRF at any time following ED triage. Conclusions: Operative patients from more socioeconomically disadvantaged neighborhoods see disparities in time to surgery for DRF. Equitable access to timely surgical care is needed and may be improved with increased access to orthopedic surgeons, patient education, support in navigating the health system, and improved continuity of fracture care. Level of Evidence: Level III

Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture

“…Although other studies have established differences in DRF treatment by socioeconomic status, the present study uniquely contributes to the literature by using an RDD to ascertain whether entry to Medicare was associated with greater parity in intensive management . The findings differed from other studies that used this quasi-experimental strategy to investigate Medicare eligibility and health equity.…”

“…Although other studies have established differences in DRF treatment by socioeconomic status, the present study uniquely contributes to the literature by using an RDD to ascertain whether entry to Medicare was associated with greater parity in intensive management. [10][11][12]56,57…”

Are There Racial and Ethnic Disparities in Management and Outcomes of Surgically Treated Distal Radius Fractures?

“…[7][8][9] This is particularly important, as it has previously been shown that there are disparities in time to surgery for DRF in patients with geographic socioeconomic disadvantage. 10 There exists substantial literature on disparities for patients undergoing arthroplasty as well as spinal surgery. Previous studies have shown increased hospital LOS, postoperative complications, and readmission rates in joint arthroplasty and spinal fusion for minority patients when compared to White patients.…”

Letter to the Editor: Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures

“…2 Our own work has demonstrated disparities in timing of distal radius fracture surgery in more disadvantaged groups. 3 The effects of these variables may very well explain the discrepancies in pain reported by the authors.…”