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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Does Socioeconomic Deprivation Correlate With Follow-Up Adherence and Clinical Outcomes in Patients With Mandible
Erica Siismets1, Richard X Dang2, Zaara Mehra3
1Resident, Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine and Boston Medical Center, Boston, MA.
Background:
Socioeconomic deprivation influences mandibular fracture prevalence, but its effect on surgical outcomes is understudied.
Purpose:
To evaluate the association between area deprivation index (ADI), a neighborhood-level measure of socioeconomic disadvantage, and follow-up appointment adherence and clinical outcomes after mandible fracture surgery.
Study Design:
Retrospective cohort study of patients aged 18 to 89 years treated for mandible fractures at Boston Medical Center from January 1, 2018, to December 31, 2022.
Exclusions:
isolated alveolus fractures, pathologic fractures, incomplete chart data, or revision procedures.
Predictor Variable:
Neighborhood-level socioeconomic deprivation, measured using ADI scores and categorized into low deprivation (score 1 to 5) or high deprivation (score 6 to 10).
Main Outcome Variables:
Primary - postoperative follow-up adherence (appointment attendance frequency). Secondary - postoperative complications and 30-day hospital readmission.
Covariates:
Demographics, socioeconomic risk factors, physiologic factors, and surgical treatment details.
Analyses:
Statistical analyses included Mann-Whitney U test, χ2 test, and Fisher's exact test. Multiple Poisson regression with log link assessed the relationship between independent variables and patient outcomes. Statistical significance set at P value < .05.
Results:
Of 1201 patients screened, 368 (33.4%) met inclusion criteria (mean age 40.9 years ± 17.1, 277 (75.3%) male). There were 197 (53.5%) and 171 (46.5%) subjects in the high- and low-ADI groups, respectively. In the high- and low-ADI groups, 84 (45.4%) and 97 (60.6%) subjects achieved a follow-up frequency of ≥70%, respectively (P = .005). Postoperative complications occurred in 30 (16.2%) and 30 (18.8%) subjects in the high- and low-ADI groups, respectively (P = .5), and 30-day readmission occurred in 12 (6.5%) and 13 (8.1%) of subjects, respectively (P = .6). In multiple Poisson regression, high ADI remained a statistically significant predictor of lower follow-up adherence (relative risk 0.81; 95% CI 0.67 to 0.99; P = .04), as did public insurance and current smoking status (relative risks 0.69 and 0.65, respectively; both P < .001).
Conclusion And Relevance:
Greater socioeconomic deprivation is associated with reduced follow-up adherence after mandible fracture repair (correlating with insurance status and cigarette use) but not with increased postoperative complications or 30-day readmissions. While ADI alone may have limited predictive value, it may contribute to broader risk models for identifying patients at risk for disengagement.