Poor Socioeconomic Status is Associated With Delayed Femoral Fracture Fixation in Adolescent Patients

Authors

Sima Vazquez, School of Medicine, New York Medical College, Valhalla, NY, USA. Electronic address: svazquez6@student.nymc.edu.
Jose F. Dominguez, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Michael Jacoby, Department of Anesthesiology, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA.
Michael Rahimi, Department of Anesthesiology, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA.
Christa Grant, Department of Pediatric Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA.
Damon DelBello, Department of Orthopaedic Pediatric Surgery, Maria Fareri Children's Hospita, Westchester Medical Center, Valhalla, NY, USA.
Irim Salik, Department of Anesthesiology, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA.

Author Type(s)

Student, Resident/Fellow, Faculty

Journal Title

Injury

First Page

111128

Document Type

Article

Publication Date

10-18-2023

Department

Anesthesiology

Second Department

Surgery

Third Department

Orthopedic Surgery

Abstract

INTRODUCTION: Healthcare disparities continue to exist in pediatric orthopedic care. Femur fractures are the most common diaphyseal fracture and the leading cause of pediatric orthopedic hospitalization. Prompt time to surgical fixation of femur fractures is associated with improved outcomes. OBJECTIVE: The objective of this study was to evaluate associations between socioeconomic status and timing of femoral fixation in adolescents on a nationwide level. METHODS: The 2016-2020 National Inpatient Sample (NIS) database was queried using International Classification of Disease, 10th edition (ICD-10) codes for repair of femur fractures. Patients between the ages of 10 and 19 years of age with a principal diagnosis of femur fracture were selected. Patients transferred from outside hospitals were excluded. Baseline demographics and characteristics were described. Patients were categorized as poor socioeconomic status (PSES) if they were classified in the Healthcare Cost and Utilization Project's (HCUP) lowest 50th percentile median income household categories and on Medicaid insurance. The primary outcome studied was timing to femur fixation. Delayed fixation was defined as fixation occurring after 24 h of admission. Secondary outcomes included length of stay (LOS) and discharge disposition. RESULTS: From 2016-2020, 10,715 adolescent patients underwent femur fracture repair throughout the United States. Of those, 765 (7.1 %) underwent late fixation. PSES and non-white race were consistently associated with late fixation, even when controlling for injury severity. Late fixation was associated with decreased rate of routine discharge (p < 0.01), increased LOS (p < 0.01) and increased total charges (p < 0.01). CONCLUSION: Patients of PSES or non-white race were more likely to experience delayed femoral fracture fixation. Delayed fixation led to worse outcomes and increased healthcare resource utilization. Research studying healthcare disparities may provide insight for improved provider education, implicit bias training, and comprehensive standardization of care.

Recommended Citation

Vazquez, S., Dominguez, J. F., Jacoby, M., Rahimi, M., Grant, C., DelBello, D., & Salik, I. (2023). Poor Socioeconomic Status is Associated With Delayed Femoral Fracture Fixation in Adolescent Patients. Injury, 54 (12), 111128. https://doi.org/10.1016/j.injury.2023.111128