SOCIOECONOMIC FACTORS ARE ASSOCIATED WITH INEQUITIES IN ACCESS TO ROTATOR CUFF REPAIR AND TIME TO SURGERY: A PROVINCIAL COHORT STUDY

Several risk factors for poor outcomes or failure have been previously identified for rotator cuff repair (RCR), such as tear size and retraction, age, diabetes, smoking, and occupational history. Duration of symptoms, and thus, time to surgery, are also important risk factors because over time, the RC tear can progress, and tendon retraction, fatty infiltration and atrophy of the muscle belly can increase the likelihood of failure. Thus far, little is known about the effects of SES on the decision of operative versus conservative treatment and time to surgery. The objective of this study is to identify if there is a difference in SES between surgical and non-surgical patients with RC tears. Secondly, the relationship between time SES and time to consult and time to surgery are explored. Data collated and analyzed through the Manitoba Centre for Health Policy (MCHP) were used as the basis for this study. Patients that underwent RCR between 2015–2020 and those that were given the same diagnostic codes from surgeons but did not proceed to surgery comprised the operative and non-operative groups. Time from general practitioner diagnosis to consult (time to consult) and time from consult to surgery (time to surgery) were also evaluated with respect to SES for patients (1990–2020). SES was operationalized using the Socioeconomic Status Factor Index-2 (SEFI-2), a composite score based on average household income, percent single parent households, unemployment rate, and high school graduation rate for a given postal code. SEFI-2 scores range from −5 to +5 with lower scores being more positive SES. Logistic regression with surgery/no surgery as the dependent variable and SEFI-2 as the independent variable were performed. Logistic regression was also performed using time to surgery and time to consult of more or less than a year as the dependent variable. 1904 patients underwent RCR in Manitoba between 2015 and 2020, compared to 2438, who did not. The mean SEFI-2 score for those that underwent RCR was −0.21 (95% CI 0.04) and for those that did not it was −0.03 (95% CI −0.04; p < 0.001). The odds ratio for those with a score greater than +1 of undergoing RCR was 0.43 (95% CI 0.11; p < 0.001) and between 0 and +1 was 0.54 (95% CI 0.11; p < 0.001) compared to other SEFI-2 score levels. 6,557 patients underwent RCR between 1990 and 2020, with 7% in the lowest SES category compared to 14% in the highest. Mean time to consult was 1.05 (95% CI 0.06) years and mean time to surgery from consult was 0.54 (95% CI 0.01). The odds of those in the lowest SES category having their surgical consult within 1 year of diagnosis was not significantly different (0.86 (95% CI 0.23) years; p=0.39); however, the odds of having surgery within 1 year of consult was significant (0.70 (95% CI 0.18) years; p=0.02). Patients with lower SES were less likely to undergo RCR and if proceeding to surgery, were less likely to have their surgery within 1 year of the orthopaedic consultation.