Background: Disparities in social determinants of health have been linked to worse patient-reported outcomes, higher postoperative pain, and increased risk of revision surgery following orthopaedic procedures. Identification of perioperative predictors of health care utilization is of particular interest to mitigate cost and improve patient outcomes. The aim of this study is to elucidate the effect of social deprivation levels, using the Area Deprivation Index (ADI), on health care utilization following the pinning of supracondylar humerus (SCH) fractures. Identifying risk factors for discrepancies in health care utilization following SCH fracture fixation can help mitigate unnecessary health care spending and improve the care of vulnerable patient populations.

Methods: This is a retrospective review of a single institution's experience with SCH fracture pinning between 2010 and 2023. Demographic variables and health care utilization data were recorded within 90 days of surgery. The ADI was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared.

Results: One thousand one hundred eighty-six patients from a single level one trauma center were included in this study. The upper, middle, and lower terciles of ADI consisted of 226, 458, and 502 patients, respectively. The most deprived tercile had greater emergency department (ED) visitation within 90 days of surgery relative to the least and intermediate-deprived terciles (incidence rate ratio [IRR] 1.85, 95% CI 1.10-3.08). Identifying as White was an independent risk factor for increased outpatient clinic utilization (IRR or 1.17, 95% CI 1.03-1.34). Higher levels of social deprivation were independent risk factors for increased ED visitation. There was no difference in 90-day inpatient readmission rates or telephone/telehealth calls made to the clinic between the least, intermediate, and most deprived patients.

Conclusions: This study begins to shed light on how social determinants of health impact the postoperative care of the pediatric orthopaedic patient and which patient populations are the most at-risk for disproportionate resource utilization after pinning of SCH fractures. Understanding these differences may lead to improved patient outcomes while decreasing potentially unnecessary burdens on the health care system.

Key concepts: (1)Social determinants of health impact the postoperative care of the pediatric patient in the setting of supracondylar humerus fractures.(2)More socially deprived patients are at higher risk of postoperative emergency department visits.(3)Patient race is shown to be a factor in postoperative clinic utilization.

Level of evidence: III, Retrospective Comparative Study.

Keywords: Closed reduction percutaneous pinning; Deprivation; Hospital readmission; Pediatric fractures; Social determinants of health; Supracondylar humerus.

© 2024 The Authors.

背景： 社会健康决定因素的不平等与较差的患者报告结果、更高的术后疼痛和在骨科手术后的翻修手术风险有关。识别围手术期医疗利用的预测因子，对于减少成本并改善患者的预后特别感兴趣。本研究的目的是阐明使用区域剥夺指数（ADI）来衡量的社会剥夺水平对肱骨远端（SCH）骨折固定术后的医疗服务利用的影响。识别影响SCH骨折固定术后医疗服务利用差异的风险因素有助于减轻不必要的医疗支出，并改善易感患者群体的护理。

方法： 本研究是对2010年至2023年间单个机构的SCH骨折固定术经验进行回顾性审查。记录了手术后90天内的人口统计变量和医疗服务利用数据。记录了ADI，并根据患者相对的社会剥夺程度将其分为三分位数。然后基于ADI三分位数对结果进行了分层并进行了比较。

结果： 本研究纳入了一级创伤中心的1186名患者。ADI上、中、下三分位数分别包括226、458和502名患者。最贫困的三分位数在手术后90天内急诊科（ED）就诊次数比最少和中间剥夺程度的三分位数高（发生率比[IRR] 1.85，95% CI 1.10-3.08）。被标识为白人是门诊利用增加的独立风险因素（IRR或1.17，95% CI 1.03-1.34）。较高的社会剥夺程度是急诊科就诊次数增多的独立风险因素。在最少、中间和最贫困患者之间，90天内的住院再入院率或诊所电话/远程医疗服务呼叫没有差异。

结论： 本研究开始揭示了社会健康决定因素如何影响儿童骨科患者的术后护理，并确定哪些患者群体在肱骨远端骨折固定后最有可能过度利用医疗资源。理解这些差异可能导致改善患者预后，同时减少对卫生系统的潜在不必要的负担。

关键概念： (1) 社会健康决定因素影响了肱骨远端骨折儿童患者的术后护理。(2) 更贫困的患者在术后急诊科就诊的风险更高。(3) 患者种族被证明是术后门诊利用的一个因素。

证据水平： III，回顾性比较研究。

关键词： 闭合复位经皮固定；剥夺；住院再入院；儿童骨折；社会健康决定因素；肱骨远端。