Impact of Socioeconomic Factors on Patient Reported Outcomes Following Operative Treatment for Ankle Fractures

Category: Ankle Introduction/Purpose: The impact of socioeconomic status on outcomes following operative treatment of ankle fractures is an emerging area of research. Recent studies have shown that lower socioeconomic status is associated with failure to return to work, increased risk of infection and amputation, and receiving care at higher cost locations. The Area Deprivation Index (ADI) is an effective measure of socioeconomic status that has been correlated with poorer outcomes in various orthopedic procedures, such as arthroscopic rotator cuff repair and total joint arthroplasty. However, the relationship between ADI and outcomes following operative treatment of ankle fractures has not been well-studied. Therefore, the purpose of this study was to evaluate the relationship between ADI and patient-reported outcomes following operative treatment of ankle fractures. Methods: This single-institution study utilized the OrthoMidas Episode of Care prospective database to identify 281 patients who underwent operative fixation for ankle fractures between January 1, 2021 and October 7, 2022. The primary outcomes were differences in FAAM, VR-12, PEG, and Patient Acceptable Symptom State (PASS) scores between patients from the least deprived (ADI tertile 1, range 1-33) and most deprived (ADI tertile 3, range 66-100) neighborhoods. Results: Of the available 281 patients, 12 did not have ADI information available. Of the remaining 270, 107 (40%) had completed 1-year patient-reported-outcomes. 130/270 (48%) of patients with ADI information available were in the most deprived neighborhoods (tertile 3, ADI range 66-100), whereas 45/270 (17%) were in the least deprived neighborhoods (tertile 1, ADI 1-33). Conclusion: This study demonstrates a clear association between neighborhood-based socioeconomic deprivation and patient reported outcomes following operative treatment for ankle fractures. The true etiology could be a function of geography or potentially modifiable patient factors. Further investigation is essential to identify areas to target interventions and improve outcomes for low socioeconomic status patients.