Impact of social determinants of health on post hospital care following orthopaedic polytrauma.

Abstract

To determine whether community socioeconomic distress, measured by the Area Deprivation Index (ADI), is associated with worse short-term clinical outcomes in orthopaedic polytrauma patients treated at an academic level I trauma center. We performed a retrospective cohort study of polytrauma patients treated for orthopaedic injuries at an academic level I trauma center (2014-2019). State ADI scores were used to classify patients as residing in a distressed community (ADI > 8; DC) versus non-distressed community (NDC). Collected variables included demographics, injury characteristics including the Injury Severity Score (ISS), insurance status, and outcomes. Primary outcomes were malunion, nonunion, and unplanned return to the operating room; secondary outcomes included disposition at discharge and follow-up duration. Among 348 patients, 193 (55.5%) resided in DC. Compared with NDC, a higher proportion of DC patients identified as Black or American Indian/Pacific Islander (p < 0.002), and DC patients more frequently had a prior smoking history (57.4%) and psychiatric illness (19.7%; both p < 0.001) and carried public insurance (p = 0.003). Mechanisms of injury differed (p = 0.045). Mean ISS was similar between DC and NDC (18.8 vs. 19.8; p = 0.435), and patients from DC were less likely to be discharged home (48.9 vs. 62.0%; p = 0.021). Rates of malunion, nonunion, and reoperation were similar between groups. Our findings indicate that orthopaedic polytrauma patients from distressed communities are disproportionately affected by factors that complicate recovery, including smoking history, psychiatric comorbidities, and insurance status. Despite these associations, ADI was not associated with short-term outcomes in our polytrauma patient population.