Low Socioeconomic Indicators Correlate with Critical Pre-Operative Glenoid Bone Loss and Care Delays.

IF 2.9 2区医学 Q1 ORTHOPEDICS Journal of Shoulder and Elbow Surgery Pub Date : 2024-10-21 DOI:10.1016/j.jse.2024.08.039

Benjamin E Neubauer, Christopher M Kuenze, Rachel E Cherelstein, Mitchell A Nader, Albert Lin, Edward S Chang

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Abstract

Background: Chronic and recurrent shoulder dislocations prior to stabilization can increase the risk of glenoid bone loss. Glenoid bone loss exceeding critical levels can lead to further instability and decreased outcomes following arthroscopic labral repair. Indicators of low socioeconomic status (SES), such as high Area Deprivation Index (ADI) and non-commercial insurance, are related to generalized delays to orthopedic care, which can cause recurrent instability and increase glenoid bone loss.

Hypothesis/purpose: Higher national ADI and non-commercial insurance would be associated with greater levels of radiographic glenoid bone loss after glenoid instability.

Methods: A retrospective study was performed with patients who underwent anterior labral repair. Chart review included demographics, course of care data, preoperative instability data, national ADI, and insurance status. The Neighborhood Atlas Website and patients' home addresses were used to obtain national ADI. Glenoid bone loss was measured using the Best-fit circle Pico method on three-dimensionally aligned magnetic resonance images (MRIs). Researchers were blinded to SES indicators during radiographic analysis. Glenoid bone loss was compared between SES indicators using one-way ANOVAs.

Results: 146 patients met inclusion criteria and had complete datasets (23.3% female; 22.4±7.0-years-old; national ADI=16.1±15.3). Patients experienced on average 9.12±6.63% glenoid bone loss. A curve fitting tool determined a quadratic non-linear regression best characterized the association of glenoid bone loss and ADI (R² = 0.392, p < 0.001). Individuals with commercial insurance experienced 8.58%±6.69% glenoid bone loss as compared to 11.78%±6.30% in individuals with Medicaid insurance (p=0.03). Critical bone loss at a threshold of 13.5% was more likely with higher national ADI (p<0.001) and Medicaid insurance (OR=2.49, CI=1.02-6.09). However, only national ADI was predictive of subcritical bone loss at a threshold of 10% (p<0.001).

Conclusion: Patients with greater national ADI and Medicaid insurance status had greater rates of critical preoperative glenoid bone loss at a threshold of 13.5%. Greater national ADI is also predictive of subcritical glenoid bone loss at a threshold of 10% and overall glenoid bone loss. Further study is needed to assess the postoperative implications of these findings in this population.

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社会经济指标低与手术前严重盂骨缺损和护理延迟有关。

背景：肩关节在稳定前长期脱位和反复脱位会增加盂骨丢失的风险。盂骨损失超过临界值会导致进一步的不稳定性，并降低关节镜下肩关节唇修复术的疗效。低社会经济地位（SES）的指标，如高地区剥夺指数（ADI）和非商业性保险，与骨科治疗的普遍延迟有关，这可能会导致复发性不稳定并增加盂骨损失。假设/目的：较高的国家ADI和非商业性保险与盂骨不稳定后放射学盂骨损失的程度有关：方法：对接受前唇修补术的患者进行回顾性研究。病历审查包括人口统计学、治疗过程数据、术前不稳定性数据、国家 ADI 和保险状况。通过 Neighborhood Atlas 网站和患者家庭住址获得了全国 ADI。在三维对齐磁共振成像（MRI）上使用最佳拟合圆皮克法测量盂骨损失。研究人员在放射学分析过程中对 SES 指标设置了盲区。使用单因素方差分析比较不同 SES 指标的釉质骨流失情况：146名患者符合纳入标准并拥有完整的数据集（23.3%为女性；22.4±7.0岁；全国ADI=16.1±15.3）。患者平均经历了 9.12±6.63% 的盂骨损失。曲线拟合工具确定二次非线性回归最能说明盂骨损失与 ADI 的关系（R2 = 0.392，p < 0.001）。参加商业保险者的盂骨丢失率为 8.58%±6.69%，而参加医疗补助保险者的盂骨丢失率为 11.78%±6.30%（P=0.03）。全国 ADI 越高，骨质流失临界值达到 13.5% 的可能性越大（p 结论：全国 ADI 越高、医疗保险越高的患者，盂骨流失的临界值越高（p=0.03）：全国 ADI 越高且有医疗补助保险的患者术前盂骨丢失达到 13.5% 临界值的几率越大。全国 ADI 较高的患者还可预测阈值为 10% 的亚临界盂骨损失和总体盂骨损失。需要进一步研究来评估这些发现对该人群的术后影响。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.