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Increased Social Deprivation Correlates With Worse Postoperative Pain and Anxiety PROMIS Scores in Distal Femur
Ndéye F Guissé1, Susan Thapa, Arakua Welbeck
1From the Department of Orthopedic Surgery, Washington University in Saint Louis, St. Louis, MO.
Introduction:
The area deprivation index (ADI) is a valuable tool for assessing patient risk holistically, yet there is limited research on the link between area deprivation and patient-reported outcomes in adult orthopaedic trauma patients after surgery. This study examines the association of ADI with both objective and subjective outcomes after surgical treatment of distal femur fractures.
Methods:
This retrospective cohort study included patients aged 18 to 80 years who presented with traumatic distal femur fractures over 7 years and were treated surgically (OTA/AO Classification 33A, 33B, and 33C) at a level 1 trauma center. Data collected included patient demographics (age, sex, and race), body mass index, tobacco and substance use, medical comorbidities, and insurance status. Patients were grouped by ADI as either most deprived (>85th percentile) or less deprived (<85th percentile), using the Neighborhood Atlas. Patient-reported outcomes (physical function, anxiety, pain, and depression) were collected at 0 to 3, 3 to 9, and 9 to 12 months postoperatively. Objective outcomes included complications, readmissions, reoperations, and 1-year mortality.
Results:
A total of 107 patients (58 females, 49 males; mean age 53.8 years) were studied. The most deprived group was younger (48.2 vs. 57.9 years) and had more Black patients (62.2% vs. 14.5%) compared with the less deprived group, which was predominantly White (83.9% vs. 35.6%). Fewer in the most deprived group had private insurance (11.9% vs. 31.7%), and more were uninsured (19.1% vs. 5%). Both groups showed notable improvements in physical function, but the most deprived group reported higher anxiety and pain scores at 3 months. Anxiety equalized at 6 months, but pain remained higher at 1 year.
Conclusions:
Patients with higher social deprivation experienced increased pain and anxiety despite similar objective outcomes. These findings should arm orthopaedic traumatologists with more insight on caring for socially deprived patients with a more nuanced approach prioritizing their risk profiles with focus on mental health and pain management.
