目的:这项研究的目的是确定不良的社会健康决定因素(SDOH)是否与桡骨远端骨折手术固定后的并发症发生率有关,并评估哪个SDOH领域(经济,教育,社会,卫生保健,或环境)与术后并发症最相关。
方法:使用国家行政索赔数据库,我们对2010~2020年间接受孤立性桡骨远端骨折开放治疗的患者进行了回顾性队列分析.根据是否存在至少一个SDOH代码和匹配的倾向评分对患者进行分层,以创建按年龄平衡的两个队列。性别(男性或女性),保险类型,和合并症。所检查的健康的社会决定因素包括经济,教育,社会,卫生保健,和环境因素。进行了多变量逻辑回归分析,以评估SDOH对90天和1年并发症发生率的单独影响。
结果:倾向匹配后,包括不良SDOH队列中的57,025名患者和对照组中的57,025名患者。面临不良SDOH的患者更有可能经历90天的并发症,包括急诊就诊(赔率(OR):3.18[95%置信区间(CI):3.07-3.29]),感染(OR:2.37[95%CI:2.12-2.66]),伤口裂开(OR:2.06[95%CI:1.72-2.49]),和1年的并发症,包括复杂区域疼痛综合征(OR:1.35[95%CI:1.15-1.58]),不愈合/不愈合(OR:1.18[95%CI:1.08-1.29]),和硬件拆卸(OR:1.13[95%CI:1.07-1.20])。此外,面临不良SDOH的患者发生90天并发症的风险显着增加,不管骨折的严重程度,有经济和社会挑战的患者发生术后90天和1年并发症的几率最高.
结论:健康的社会决定因素与桡骨远端骨折固定术后并发症增加有关,即使控制人口统计学和临床因素。我们建议对不良SDOH进行常规筛查,并将SDOH数据纳入健康记录,不仅可以为基于结果的质量测量提供质量改进计划和风险调整,还可以让提供者在围手术期开始讨论和解决此类障碍。
方法:预后II。
OBJECTIVE: The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of distal radius fractures and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with postoperative complications.
METHODS: Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and environmental factors. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates.
RESULTS: After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07-3.29]), infection (OR: 2.37 [95% CI: 2.12-2.66]), wound dehiscence (OR: 2.06 [95% CI: 1.72-2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15-1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08-1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07-1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications.
CONCLUSIONS: Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the perioperative period.
METHODS: Prognosis II.