PMID- 30554898
OWN - NLM
STAT- MEDLINE
DCOM- 20190625
LR  - 20190625
IS  - 1879-0267 (Electronic)
IS  - 0020-1383 (Linking)
VI  - 50
IP  - 2
DP  - 2019 Feb
TI  - The association between patient education level and economic status on outcomes
      following surgical management of (fracture) non-union.
PG  - 344-350
LID - S0020-1383(18)30728-9 [pii]
LID - 10.1016/j.injury.2018.12.013 [doi]
AB  - BACKGROUND: Socioeconomic disparities are an inherent and currently unavoidable
      aspect of medicine. Knowledge of these disparities is an essential component
      towards medical decision making, particularly among an increasingly diverse
      population. While healthcare disparities have been elucidated in a wide variety
      of orthopaedic conditions and management options, they have not been established 
      among patients who present for treatment of an ununited fracture. The purpose of 
      this study is to answer the following questions: 1) Following surgical management
      of (fracture) non-unions, are there differences in outcomes between differing
      ethnic groups? 2) Following surgical management of (fracture) non-unions, are
      there differences in outcomes between patients with differing education levels?
      3) Following surgical management of (fracture) non-unions, are there differences 
      in outcome between patients with differing incomes? METHODS: Between September
      2004 and December 2017, operatively treated patients who presented with a long
      bone fracture non-union were prospectively followed. These patients presented
      with a variety of fracture non-unions that underwent surgical intervention.
      Sociodemographic factors were recorded at presentation. Long-term outcomes were
      evaluated using the Short Musculoskeletal Function Assessment (SMFA), pain
      scores, post-operative complications and physical exam at latest follow up. The
      SMFA is a 46-item questionnaire, assessing patient functional and emotional
      response to musculoskeletal ailments. RESULTS: Three-hundred-twenty-nine patients
      met inclusion criteria. Patients with a lower education had worse long-term
      functional outcomes (P < 0.001) and increased pain scores (P = 0.002) at latest
      follow-up. Patients who made less than $50,000 annually had worse long-term
      functional outcomes (P = 0.002) and reported higher pain scores (P = 0.003)
      following surgical management of (fracture) non-unions. Multiple linear
      regression demonstrated education level to be an independent predictor of
      long-term functional outcomes following surgical management of (fracture)
      non-unions (B= -0.154, 95% Confidence Interval [CI]=-10.96 to -1.26, P = 0.014). 
      No differences existed in outcomes or pain scores between those of different
      ethnic groups. No differences existed regarding post-operative complications and 
      time to union between patients of different ethnic groups, educational levels and
      income status. CONCLUSION: Patients with lower education levels and individuals
      who make less than $50,000 annually have worse functional outcomes following
      surgical management of (fracture) non-unions. Orthopaedic trauma surgeons should 
      therefore be aware of these disparities, and consider early interventions aimed
      at optimizing patient recovery in these subsets.
CI  - Copyright (c) 2018 Elsevier Ltd. All rights reserved.
FAU - Kugelman, David N
AU  - Kugelman DN
AD  - NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003, United
      States. Electronic address: david.kugelman@nyumc.org.
FAU - Haglin, Jack M
AU  - Haglin JM
AD  - NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003, United
      States. Electronic address: Jackhaglin@gmail.com.
FAU - Carlock, Kurtis D
AU  - Carlock KD
AD  - NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003, United
      States. Electronic address: Kurtis.carlock@nyumc.org.
FAU - Konda, Sanjit R
AU  - Konda SR
AD  - NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003, United
      States. Electronic address: Sanjit.konda@nyumc.org.
FAU - Egol, Kenneth A
AU  - Egol KA
AD  - NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10003, United
      States. Electronic address: kenneth.egol@nyumc.org.
LA  - eng
PT  - Journal Article
DEP - 20181206
PL  - Netherlands
TA  - Injury
JT  - Injury
JID - 0226040
SB  - IM
MH  - Adult
MH  - Educational Status
MH  - Ethnic Groups
MH  - Female
MH  - *Fracture Fixation, Internal/statistics & numerical data
MH  - Fractures, Bone/economics/epidemiology/*surgery
MH  - Fractures, Ununited/economics/epidemiology/*surgery
MH  - Health Services Research
MH  - Healthcare Disparities/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/economics/*epidemiology
MH  - Prospective Studies
MH  - Socioeconomic Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
OTO - NOTNLM
OT  - Educational disparities
OT  - Fracture disparities
OT  - Non-union
OT  - Orthopaedic disparities
OT  - Orthopaedic trauma disparities
EDAT- 2018/12/18 06:00
MHDA- 2019/06/27 06:00
CRDT- 2018/12/18 06:00
PHST- 2018/04/01 00:00 [received]
PHST- 2018/10/01 00:00 [revised]
PHST- 2018/12/04 00:00 [accepted]
PHST- 2018/12/18 06:00 [pubmed]
PHST- 2019/06/27 06:00 [medline]
PHST- 2018/12/18 06:00 [entrez]
AID - S0020-1383(18)30728-9 [pii]
AID - 10.1016/j.injury.2018.12.013 [doi]
PST - ppublish
SO  - Injury. 2019 Feb;50(2):344-350. doi: 10.1016/j.injury.2018.12.013. Epub 2018 Dec 
      6.