Testa Edward J, Brodeur Peter G, Li Lambert T, Berglund-Brown Isabella S, Modest Jacob M, Gil Joseph A, Cruz Aristides I, Owens Brett D
Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A.
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A.
Arthrosc Sports Med Rehabil. 2022 Jul 19;4(4):e1497-e1504. doi: 10.1016/j.asmr.2022.06.001. eCollection 2022 Aug.
To assess independent predictors of surgery after an emergency department visit for shoulder instability, including patient-related and socioeconomic factors.
Patients presenting to the emergency department were identified in the New York Statewide Planning and Research Cooperative System database from 2015 to 2018 by diagnosis codes for anterior shoulder dislocation or subluxation. All shoulder stabilization procedures in the outpatient setting were identified using Current Procedural Terminology codes (23455, 23460, 23462, 23466, and 29806). A multivariable logistic regression was performed to assess the impact of patient factors on the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation, Charlson Comorbidity Index, recurrent dislocation, and primary insurance type.
In total, 16,721 patients with a shoulder instability diagnosis were included in the analysis and 1,028 (6.1%) went on to have surgery. Patients <18 years old (odds ratio [OR] 8.607, < .0001), those with recurrent dislocations (OR 2.606, < .0001), or worker's compensation relative to private insurance (OR 1.318, = .0492) had increased odds of receiving surgery. Hispanic (OR 0.711, = .003) and African American (OR 0.63, < .0001) patients had decreased odds of surgery compared with White patients. Patients with Medicaid (OR 0.582, < .0001) or self-pay (OR 0.352, < .0001) insurance had decreased odds of undergoing surgery relative to privately insured patients. Patients with greater levels of social deprivation (OR 0.993, < .0001) also were associated with decreased odds of surgery.
Anterior glenohumeral instability and subsequent stabilization surgery is associated with disparities among patient race, primary insurance, and social deprivation.
Considering the relationship between differential care and health disparities, it is critical to define and increase physician awareness of these disparities to help ensure equitable care.
评估因肩部不稳定到急诊科就诊后进行手术的独立预测因素，包括患者相关因素和社会经济因素。
通过前肩关节脱位或半脱位的诊断代码，在2015年至2018年纽约州全州规划与研究合作系统数据库中识别出到急诊科就诊的患者。使用当前手术操作术语代码（23455、23460、23462、23466和29806）识别门诊环境中的所有肩部稳定手术。进行多变量逻辑回归以评估患者因素对接受手术可能性的影响。分析中纳入的变量包括年龄、性别、种族、社会剥夺、查尔森合并症指数、复发性脱位和主要保险类型。
总共16721例诊断为肩部不稳定的患者纳入分析，其中1028例（6.1%）接受了手术。18岁以下患者（比值比[OR]8.607，P<0.0001）、复发性脱位患者（OR 2.606，P<0.0001）或相对于私人保险的工伤赔偿患者（OR 1.318，P=0.0492）接受手术的几率增加。与白人患者相比，西班牙裔患者（OR 0.711，P=0.003）和非裔美国患者（OR 0.63，P<0.0001）接受手术的几率降低。与私人保险患者相比，医疗补助保险（OR 0.582，P<0.0001）或自费保险（OR 0.352，P<0.0001）的患者接受手术的几率降低。社会剥夺程度较高的患者（OR 0.993，P<0.0001）接受手术的几率也较低。
肩肱关节前不稳定及随后的稳定手术与患者种族、主要保险和社会剥夺方面的差异有关。
考虑到差异化医疗与健康差异之间的关系，明确并提高医生对这些差异的认识对于确保公平医疗至关重要。
