Do Social Deprivation and Surgical Volume Influence Outcomes Following Distal Radius Fracture Fixation?

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Health Equity

Background:

• Distal radius fractures are common in adults, with increasing rates of surgical fixation.
• Understanding factors influencing surgical outcomes is crucial for patient care.
• Surgeon and hospital procedural volume are potential indicators of care quality.

Purpose of the Study:

• To investigate the association between surgeon/hospital volume and complications after distal radius fixation.
• To determine if patient demographics and socioeconomic factors correlate with provider volume.
• To assess the impact of volume on specific adverse outcomes like infection and reoperation.

Main Methods:

• Retrospective analysis of 14,748 distal radius fracture cases from 2009-2015 using the NYS-PCSR database.
• Calculation of annual procedure volume for facilities and surgeons.
• Comparison of complication rates (infection, carpal tunnel surgery, revision) and patient characteristics (including Social Deprivation Index) between low-volume (LV) and high-volume (HV) providers.

Main Results:

• Low-volume facilities and surgeons were associated with higher 3-month risks of infection requiring reoperation.
• Patients treated by LV providers had a higher Social Deprivation Index (SDI).
• HV facilities were less likely to treat Hispanic patients, those with comorbidities, higher SDI, or Federal/self-pay insurance.

Conclusions:

• Lower surgeon and hospital volume correlates with increased risk of surgical site infection and reoperation for distal radius fractures.
• Low-volume providers disproportionately serve disadvantaged populations (higher SDI, comorbidities, minority status), potentially exacerbating health disparities.
• High-volume centers may offer more equitable care, but also appear to serve a less diverse patient demographic.