The Effects Of Social Determinants Of Health Among Patients Undergoing Shoulder Stabilization Surgery
Recommended Citation
Kasto J, Castle J, Nerys-Figueroa J, Pratt B, Frei A, Bolton M, Jurayj A, Mahylis JM, Moutzouros V, Muh S. The Effects Of Social Determinants Of Health Among Patients Undergoing Shoulder Stabilization Surgery. JSES International 2024; 8(6):1368.
Document Type
Conference Proceeding
Publication Date
10-21-2024
Publication Title
JSES International
Abstract
Aim: The purpose of this study was to investigate the impact of the social determinants of health (SDOH) on the number of shoulder dislocation events before patients underwent surgical stabilization. Background: SODH is comprised of a patient’s environmental conditions including social and economic factors which influence access to healthcare and resources. Growing evidence in orthopaedic surgery has revealed that SDOH factors lead to differential access to care and ultimately health disparities after surgery. Previous literature has demonstrated that the number of previous dislocations before shoulder stabilization surgery increases the risk of recurrent instability after the surgical procedure. Methods: A retrospective review of patients who underwent shoulder stabilization surgery at a single center between 1/1/2018 to 5/1/2023 were identified. Patient demographic, characteristic, and social determinant data were collected using the electronic medical record from a single metropolitan health system. Area of deprivation index (ADI) data were collected using online mapping data based on patient zip codes. The number of dislocation events and the date of the first dislocation were recorded. Operative variables collected included date of surgery and the procedure performed to determine the time from dislocation to clinical presentation and from clinical presentation to shoulder stabilization surgery. Patients were stratified in ADI quartiles (Q1=least deprived to Q4=most deprived) and descriptive characteristics were summarized. Results: A total of 445 patients were who had at least one shoulder dislocation and underwent shoulder stabilization surgery were included. Baseline patient characteristics varied among the ADI quartiles with average age at surgery (in years; Q1=20.5, Q2=24.6, Q3=25.0, Q4=26.4, p<0.01), average body mass index (in kg/m2; Q1=26.2, Q2=26.1, Q3=26.9, Q4=28.2, p<0.01), average weeks from first shoulder dislocation to clinical presentation (Q1=43.4 ± 92.1, Q2= 100.0 ± 196.0, Q3= 87.5 ± 133.4, Q4= 107.5 ± 168.4, p<0.03), and the occurrence of having one shoulder instability event versus multiple events before undergoing stabilization surgery (multiple instability events, Q1=35 [62.5%], Q2=72 [56.7%], Q3=77 [65.8%], Q4=108 [74.5%]; p=0.02). Patient sex and time from clinical presentation to stabilization surgery were not significant between ADI quartiles. Non-White patients were overrepresented in the most-deprived quartile (Q4=99, [68.3%]) compared to the least-deprived quartile (Q1=17 [30.4%]; p<0.01). Conclusion: This study demonstrated that marginalized groups suffered more shoulder dislocation events before undergoing shoulder stabilization surgery and presented to an orthopaedic surgeon later than their less-deprived counterparts. Upon presentation to an orthopaedic surgeon, time from presentation to surgery was not different emphasizing the importance of health care accessibility.
Volume
8
Issue
6
First Page
1368
