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Public Insurance Is Associated with Delays to Surgery in Pediatric Patients with a First-Time Patellar Dislocation
Alexandra Dejneka1,2, Amin M Alayleh1, David Kell3
1Division of Orthopaedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Children with public insurance and older children experience delays in surgery for first-time patellar dislocations with loose bodies. These delays reduce the chance of successful osteochondral fixation, highlighting care disparities.
Area of Science:
- Pediatric Orthopaedics
- Health Services Research
Background:
- First-time patellar dislocations with loose bodies necessitate prompt surgery to prevent further intra-articular damage.
- Social determinants and demographics are linked to delayed interventions for pediatric orthopaedic injuries.
Purpose of the Study:
- To investigate how demographic factors influence surgical timing for pediatric patients experiencing first-time patellar dislocations with loose bodies.
Main Methods:
- Retrospective comparative study of 163 patients under 19 years old at two urban tertiary children's hospitals (2007-2021).
- Exclusion criteria included genetic syndromes, neuromuscular conditions, or recurrent instability.
- Analysis focused on demographic data (age, sex, race, ethnicity, insurance) and injury-to-surgery timing, using univariable and multivariable regression.
Main Results:
- Median surgery time was longer for publicly insured patients (55 days) vs. privately insured (38.5 days) (P=.005).
- Publicly insured children had higher odds of surgery >30 days post-injury (OR 2.3, P=.04).
- Older age was associated with increased odds of delayed surgery (OR 1.2 per year, P=.02), and delayed surgery lowered osteochondral fixation likelihood.
Conclusions:
- Surgical intervention for pediatric patellar dislocations with loose bodies is delayed in older children and those with public insurance.
- Delayed treatment negatively impacts the likelihood of osteochondral fixation.
- Addressing these disparities is crucial for equitable pediatric orthopaedic care.
Background:
First-time patellar dislocations with a loose body require prompt operative treatment to prevent further intra-articular damage. Social determinants and demographic characteristics have been associated with delays in pediatric orthopaedic injuries requiring less urgent interventions. The purpose of this study was to examine the impact of demographic factors on surgical timing for children with first-time patellar dislocations involving a loose body.
Methods:
This is a retrospective comparative study of patients <19 years of age undergoing surgery for a first-time patellar dislocation with a loose body or unstable osteochondral fracture at two urban tertiary children's hospitals between 2007 and 2021. Patients with an underlying genetic syndrome, neuromuscular condition, or recurrent instability were excluded. Demographic data included age, sex, race, ethnicity, and insurance. Clinical data were also collected, with attention to the timing between injury and surgery. Univariable analysis was followed by multivariate regression. Odds ratios are reported with 95% confidence intervals (CIs).
Results:
A total of 163 patients met study inclusion criteria (mean age 14.7 ± 2.4 years, 55.3% girls). The median time between injury and surgery for patients with public insurance was 55 days (interquartile range, IQR, 204 days) compared to 38.5 days (IQR 55 days) for those with private insurance (P = .005). Compared to privately insured children, a higher proportion of those with public insurance had surgery beyond 30 days after injury (80.4% vs 63.7%, P = .04). Patients who underwent fixation of their loose body had surgery a median of 33 days after injury (IQR 30 days), while those who underwent removal had surgery 48.5 days after injury (IQR 69 days, P = .04). In regression analysis, children with public insurance had 2.3 times higher odds of undergoing surgery later than 30 days after injury (95% CI: 1.1-5.2, P = .04). Each year of increasing age was associated 1.2 times higher odds of surgery beyond 30 days postinjury (95% CI: 1.0, 1.4, P = .02).
Conclusions:
Time to surgical intervention in pediatric patients with first-time patellar dislocations involving a loose body was significantly delayed in older children and those with public insurance. Delayed surgery is associated with a lower likelihood of osteochondral fixation. Identifying the underlying mechanisms of these disparities can facilitate more equitable care for pediatric patients with patellar instability.
Key Concepts:
(1)Public insurance is associated with longer delays to surgery for pediatric patients with a first-time patellar dislocation involving a loose body.(2)Older age is independently associated with delayed surgical intervention in this patient population.(3)Delayed treatment for these injuries lowers the likelihood of osteochondral fixation.(4)Identifying and addressing disparities is necessary to promote equitable pediatric orthopaedic care.
Level Of Evidence:
Level III.
