Jesse Isaac Wolfstadt1, Daniel Pincus1, Hans J. Kreder1, David Wasserstein1. 1. From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder).
Abstract
Background: Few studies have investigated the outcomes of surgical fracture care among socially deprived patients despite the increased incidence of fractures and the inequality of care received in this group. We evaluated whether socioeconomic deprivation affected the complications and subsequent management of marginalized/homeless patients following surgery for ankle fracture. Methods: In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45 444 patients who underwent open reduction and internal fixation (ORIF) for ankle fracture performed by 710 different surgeons between Jan. 1, 1994, and Dec. 31, 2011. Multivariable logistic regression models were used to assess the association between deprivation and shorter-term outcomes within 1 year (implant removal, repeat ORIF, irrigation and débridement owing to infection, and amputation). Multivariable Cox proportional hazards models were used to assess longer-term outcomes up to 20 years (ankle fusion and ankle arthroplasty). Results: A higher level of deprivation was associated with an increased risk of irrigation and débridement (quintile 5 v. quintile 1: odds ratio [OR] 2.14, 95% confidence interval [CI] 1.25–3.67, p = 0.0054) and amputation (quintile 4 v. quintile 1: OR 3.56, 95% CI 1.01–12.4, p = 0.0466). It was more common for less deprived patients to have their hardware removed (quintile 5 v. quintile 1: OR 0.822, 95% CI 0.76–0.888, p < 0.0001). There was no correlation between marginalization and subsequent revision ORIF, ankle fusion, or ankle arthroplasty. Conclusion: Marginalized patients are at a significantly increased risk of infection and amputation following surgical treatment of ankle fractures. However, these complications are still extremely uncommon among this group. Socioeconomic deprivation should not prohibit marginalized patients from receiving surgery for unstable ankle fractures.
Background: Few studies have investigated the outcomes of surgical fracture care among socially deprived patients despite the increased incidence of fractures and the inequality of care received in this group. We evaluated whether socioeconomic deprivation affected the complications and subsequent management of marginalized/homeless patients following surgery for ankle fracture. Methods: In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45 444 patients who underwent open reduction and internal fixation (ORIF) for ankle fracture performed by 710 different surgeons between Jan. 1, 1994, and Dec. 31, 2011. Multivariable logistic regression models were used to assess the association between deprivation and shorter-term outcomes within 1 year (implant removal, repeat ORIF, irrigation and débridement owing to infection, and amputation). Multivariable Cox proportional hazards models were used to assess longer-term outcomes up to 20 years (ankle fusion and ankle arthroplasty). Results: A higher level of deprivation was associated with an increased risk of irrigation and débridement (quintile 5 v. quintile 1: odds ratio [OR] 2.14, 95% confidence interval [CI] 1.25–3.67, p = 0.0054) and amputation (quintile 4 v. quintile 1: OR 3.56, 95% CI 1.01–12.4, p = 0.0466). It was more common for less deprived patients to have their hardware removed (quintile 5 v. quintile 1: OR 0.822, 95% CI 0.76–0.888, p < 0.0001). There was no correlation between marginalization and subsequent revision ORIF, ankle fusion, or ankle arthroplasty. Conclusion: Marginalized patients are at a significantly increased risk of infection and amputation following surgical treatment of ankle fractures. However, these complications are still extremely uncommon among this group. Socioeconomic deprivation should not prohibit marginalized patients from receiving surgery for unstable ankle fractures.
Authors: Earl R Bogoch; Victoria Elliot-Gibson; Dorcas E Beaton; Sophie A Jamal; Robert G Josse; Timothy M Murray Journal: J Bone Joint Surg Am Date: 2006-01 Impact factor: 5.284
Authors: Harrison F Kay; Vasanth Sathiyakumar; Kristin R Archer; Shannon L Mathis; Jordan C Apfeld; Young M Lee; A Alex Jahangir; Jesse Ehrenfeld; William T Obremskey; Manish K Sethi Journal: J Orthop Trauma Date: 2014-06 Impact factor: 2.512
Authors: Kenneth J Koval; Weiping Zhou; Michael J Sparks; Robert V Cantu; Paul Hecht; Jon Lurie Journal: Foot Ankle Int Date: 2007-12 Impact factor: 2.827
Authors: Nelson F SooHoo; Lucie Krenek; Michael J Eagan; Barkha Gurbani; Clifford Y Ko; David S Zingmond Journal: J Bone Joint Surg Am Date: 2009-05 Impact factor: 5.284