Public Insurance Is Associated with Delays to Surgery in Pediatric Patients with a First-Time Patellar Dislocation...

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.