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American Association for Hand Surgery

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Social Disparities in the Surgical Management of Metacarpal Shaft Fractures
Peter G Brodeur, MA1, Devan D Patel, MD1, Jeremy E Raducha, MD1, Aristides I Cruz, Jr., MD, MBA1 and Joseph A Gil, MD2, (1)Alpert Medical School of Brown University, Providence, RI, (2)Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI

Introduction: The examination and reduction of disparities and their causative factors in orthopaedic surgical care is crucial. Metacarpal shaft fractures are common outcomes of hand trauma and can be managed both operatively and nonoperatively. This study investigated the relationship between social, economic, and demographic factors and rates of surgical vs. nonsurgical management of adult metacarpal shaft fractures.
Materials & Methods: Claims for adult patients (≥18 years old) diagnosed with a metacarpal shaft fracture were identified with International Classification of Diseases (ICD)-9 Clinical Modification and ICD-10 CM codes from 2011-2018 in the New York Statewide Planning and Research Cooperative System (SPARCS) database. SPARCS is an all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. Patients were followed for 6 months to identify whether they underwent surgery using Current Procedural Terminology codes 26615 and 26608. Multivariable logistic regression was performed to evaluate the effect of patient demographic factors on the likelihood of patients receiving surgical vs. nonsurgical management. The variables included in the analysis were patient age, sex, race, ethnicity, social deprivation index (SDI), Charlson Comorbidity Index (CCI), and primary insurance type.
Results: 11,324 patients with metacarpal shaft fractures were identified and 1,611 (14.2%) underwent surgery. Increased age (OR=0.985, p=<.0001), female sex (OR=0.873, p=0.044), African American (OR=0.747, p=0.0003), Medicare (OR=0.582, p=<.0002), self-pay (OR=0.565, p=<.0001), and those with higher social deprivation (SDI) (OR=0.997, p=0.0048) had a decreased likelihood of undergoing surgery (Table 2).
Conclusions: The results demonstrate a biased management of metacarpal shaft fractures in adults according to various socioeconomic factors. Considering the relationship between differential care and health disparities, it is critical to define the disparities involved and to increase physician awareness to promote appropriate management of metacarpal shaft fractures.



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