Social Disparities in Outpatient and Inpatient Management of Pediatric Supracondylar Humerus Fractures

Abstract

Socioeconomic status, race, and insurance status are known factors affecting adult orthopaedic surgery care, but little is known about the influence of socioeconomic factors on pediatric orthopaedic care. The purpose of this study was to determine if demographic and socioeconomic related factors were associated with surgical management of pediatric supracondylar humerus fractures (SCHFs) in the inpatient versus outpatient setting. Pediatric patients (<13 years) who underwent surgery for SCHFs were identified in the New York Statewide Planning and Research Cooperative System database from 2009–2017. Inpatient and outpatient claims were identified by International Classification of Diseases-9-Clinical Modification (CM) and ICD-10-CM SCHF diagnosis codes. Claims were then filtered by ICD-9-CM, ICD-10-Procedural Classification System, or Current Procedural Terminology codes to isolate SCHF patients who underwent surgical intervention. Multivariable logistic regression analysis was performed to determine the effect of patient factors on the likelihood of having inpatient management versus outpatient management. A total of 7079 patients were included in the analysis with 4595 (64.9%) receiving inpatient treatment and 2484 (35.1%) receiving outpatient treatment. The logistic regression showed Hispanic (OR: 2.386, p < 0.0001), Asian (OR: 2.159, p < 0.0001) and African American (OR: 2.095, p < 0.0001) patients to have increased odds of inpatient treatment relative to White patients. Injury diagnosis on a weekend had increased odds of inpatient management (OR: 1.863, p = 0.0002). Higher social deprivation was also associated with increased odds of inpatient treatment (OR: 1.004, p < 0.0001). There are disparities among race and socioeconomic status in the surgical setting of SCHF management. Physicians and facilities should be aware of these disparities to optimize patient experience and to allow for equal access to care.

The intersection of pediatric anesthesiology and social determinants of health

“…A connection between SDOH and surgical treatment and in-hospital outcomes has also been reported in pediatric patients undergoing surgery for supracondylar humerus fractures, appendectomy, and tonsil and adenoidectomy. Modest et al [21 ▪▪ ] assessed whether social disadvantage, as measured by the Social Deprivation Index (SDI), was associated with likelihood of outpatient vs. inpatient surgical management of pediatric supracondylar humerus fractures and higher social deprivation was associated with increased odds of requiring inpatient surgery. However, fracture type nor severity was accounted for in study analyses, which may have influenced the surgical admission decision.…”

Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis

“…[1][2][3][4][5][6][7] There is increasing interest regarding the effect of health care disparities on the accessibility and delivery of pediatric orthopaedic care in the United States. [1][2][3][8][9][10][11][12] It is known that children with publicly funded insurance wait longer to access general pediatric orthopaedic care, including scoliosis care. [13][14][15] A recent significant emphasis on understanding the root causes of such disparities as they pertain to adolescent idiopathic scoliosis (AIS) care exists.…”

“…Children with publicly funded insurance, an indirect marker of socioeconomic status (SES), household income, and ethnicity are significantly more likely to experience unmet health care needs, obesity, and potentially poorer surgical outcomes 1–7 . There is increasing interest regarding the effect of health care disparities on the accessibility and delivery of pediatric orthopaedic care in the United States 1–3,8–12 . It is known that children with publicly funded insurance wait longer to access general pediatric orthopaedic care, including scoliosis care 13–15 .…”