Socioeconomic deprivation and preoperative presentation in elective foot and ankle surgical patients in the southeastern US.

Abstract

There are gaps remaining in understanding how social deprivation varies across practice settings, particularly as it relates to orthopaedic foot and ankle surgical populations. The Area Deprivation Index (ADI) is a tool that allows for the comparison of various social determinants of health at the neighborhood level that may ultimately impact a person's overall quality of life. In this investigation, a retrospective observational study was performed to identify patients presenting for elective foot and ankle surgical intervention. Baseline physical function was assessed through the prospective administration of three patient-reported outcome measures. Ultimately, a total of 372 patients met the inclusion criteria for analysis. Patients were grouped into tertiles according to their state ADI deciles, with the first tertile representing less deprivation and the third representing greater deprivation. The median Foot Functional Index score was statistically significantly different (H = 17.318, P < 0.001). Post-hoc comparisons indicated significant differences between the first and second tertiles (P < 0.001) and the first and third tertiles (P < 0.001). There were no significant associations between ADI tertile and duration of reported symptoms (p = 0.463). Median patient-reported pain was significantly greater among the second and third tertiles relative to the median reported scores in the first tertile. Among a population in the southeastern United States, patients presenting for elective foot and ankle surgery from areas of greater social deprivation were observed to report increased pain and relatively lower physical function compared to those from areas of less deprivation.