Testa Edward J, Modest Jacob M, Brodeur Peter, Lemme Nicholas J, Gil Joseph A, Cruz Aristides I
Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02904, USA.
J Racial Ethn Health Disparities. 2023 Feb;10(1):319-324. doi: 10.1007/s40615-021-01222-1. Epub 2022 Jan 10.
Anterior cruciate ligament (ACL) injuries may be managed nonoperatively in certain patients and injury patterns; however, complete ACL ruptures are commonly reconstructed to restore anterior and lateral rotatory stability of the knee. While ACL reconstruction is well-studied, the literature is sparse with regard to which socioeconomic patient factors are associated with patients undergoing ACL reconstruction rather than nonoperative management after diagnosis of an ACL injury. The current study seeks to evaluate this relationship between patient demographics as well as socioeconomic factors and the rate of surgery following ACL injuries.
Patients ≤65 years of age with a primary ACL injury between 2011 and 2018 were retrospectively identified in the New York Statewide Planning and Research Cooperative System database. International Classification of Disease 9/10 and Current Procedural Terminology codes were used to identify these patients and their subsequent ACL reconstructions. Logistic regression was performed to determine the effect of patient factors on the likelihood of having surgery after the diagnosis of an ACL injury.
Compared to White patients, African American patients were significantly less likely to undergo ACL reconstruction following an ACL injury (OR=0.65, 95% CI, 0.573-0.726). Patients older than 35 had decreased odds of undergoing ACL reconstruction compared to younger patients, with patients 55-64 having the lowest odds (OR=0.166, 95% CI, 0.136-0.203). Patients with Medicaid (OR=0.84, 95% CI, 0.757-0.933) or self-pay insurance (OR=0.67, 95% CI, 0.565-0.793), and those with worker's compensation (OR=0.715, 95% CI, 0.621-0.823) had decreased odds of undergoing ACL reconstruction relative to patients with private insurance. Patients with higher Social Deprivation Index (SDI) were significantly more likely to be treated nonoperatively after ACL injuries compared to those with lower SDI (mean nonoperative SDI score, 61, operative SDI, 56, P<0.0001).
In patients with ACL injuries, there are socioeconomic and patient-related factors that are associated with increased odds of undergoing ACL reconstruction. These factors are important to recognize as they represent a source of potential inequality in access to care and an area with potential for improvement.
对于某些患者和损伤类型，前交叉韧带（ACL）损伤可以采用非手术治疗；然而，ACL完全断裂通常需要进行重建手术，以恢复膝关节的前向和侧向旋转稳定性。虽然ACL重建手术已经得到了充分的研究，但关于哪些社会经济因素与ACL损伤诊断后接受ACL重建手术而非非手术治疗的患者相关的文献却很少。本研究旨在评估患者人口统计学特征以及社会经济因素与ACL损伤后手术率之间的关系。
在纽约州全州规划与研究合作系统数据库中，回顾性识别2011年至2018年间初次ACL损伤且年龄≤65岁的患者。使用国际疾病分类第9/10版和当前手术操作术语代码来识别这些患者及其随后的ACL重建手术。进行逻辑回归分析，以确定患者因素对ACL损伤诊断后进行手术可能性的影响。
与白人患者相比，非裔美国患者在ACL损伤后接受ACL重建手术的可能性显著降低（比值比[OR]=0.65，95%置信区间[CI]，0.573 - 0.726）。与年轻患者相比，35岁以上的患者接受ACL重建手术的几率降低，55 - 64岁的患者几率最低（OR=0.166，95% CI，0.136 - 0.203）。与拥有私人保险的患者相比，参加医疗补助计划（OR=0.84，95% CI，0.757 - 0.933）或自费保险（OR=0.67，95% CI，0.565 - 0.793）的患者，以及获得工伤赔偿的患者（OR=0.715，95% CI，0.621 - 0.823）接受ACL重建手术的几率降低。与社会剥夺指数（SDI）较低的患者相比，SDI较高的患者在ACL损伤后接受非手术治疗的可能性显著更高（非手术治疗的SDI平均得分61，手术治疗的SDI为56，P<0.0001）。
在ACL损伤患者中，存在一些社会经济和患者相关因素，这些因素与接受ACL重建手术的几率增加有关。认识到这些因素很重要，因为它们代表了获得医疗服务方面潜在不平等的一个来源，也是一个有改进潜力的领域。
