Social deprivation results in longer perioperative admission and decreased rates of home discharge after distal femur fracture.

Abstract

Distal femur fractures (DFF) are orthopaedic injuries associated with poor outcomes, despite recent improvements in technology. Perhaps socioeconomic distress is a factor influencing DFF outcomes. The purpose of this study was to investigate the impact of social deprivation via the Area Deprivation Index (ADI) in the perioperative period after DFF. This was a retrospective review carried out at a Level I Academic Trauma Center of patients ≥ 55 years old with operatively treated distal femur fractures from 2000-2023. Demographic information, Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), preoperative functional independence, ipsilateral or contralateral lower extremity fracture, mechanism of injury, fracture characteristics, discharge disposition, and length of stay were recorded. ADI was used to categorize patients into least deprived tercile (LDT, 0-33), intermediate deprived tercile (IDT, 34-67), and most deprived tercile (MDT, 68-100). Inpatient length of stay and discharge disposition were compared among LDT, IDT, and MDT. A total of 427 patients were included in the study, 58 (13.5 %) MDT, 155 (36 %) IDT, and 214 (50.5 %) LDT. The mean age was 60.2+-18.2 years. In comparison to MDT, LDT were significantly more female (67.8 % v 53.4 %, p = 0.043), Caucasian (93.8 % v 68.4 %, P < 0.001), less likely to be injured from a fall from height (6.1 % vs 19.0 %, p = 0.032), have a prolonged length of stay (40.2 % vs 55.2 %, p = 0.041), and be a former smoker (17.7 % vs 27.8 %, p = 0.050). When controlling for gender, race, injury severity, and preoperative functional independence, MDT were 2.1 times more likely to have a prolonged hospital stay in comparison to LDT (95 % CI 1.0 - 4.5, p = 0.049). MDT were 2.9 times more likely to discharge to a skilled nursing facility or inpatient rehabilitation location (95 % CI 1.2 - 7.2, p = 0.019) in comparison to LDT after controlling for age, gender, race, alcohol use, mechanism of injury, and length of hospitalization. Following distal femur fracture fixation, the most socially deprived patients are likely to have a longer stay in the hospital and a greater chance of non-home discharge. Future interventions should be aimed at minimizing socioeconomic barriers that impact discharge timing and location. III.