American Association for Hand Surgery
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Health Disparities in Hand and Upper Extremity Surgery: A Scoping Review
Kevin Chen, BA; Grace Y. Duan, BA; Jeffrey G Stepan, MD, MS
University of Chicago, Chicago, IL

Introduction: Hand surgeons provide care to a diverse population. Although social determinants of health (SDOH), such as race/ethnicity, education, and deprivation indices, have been linked to poor healthcare outcomes, there is a paucity of research assessing health disparities within hand surgery. Thus, we conducted a scoping review to understand the existing literature and identify further areas for research.
Methods: We conducted a systematic search of PubMed, Scopus, and Cochrane according to PRISMA guidelines. Inclusion criteria were English studies pertaining to health disparities in hand surgery. The following attributes were assessed: main disease/injury/procedure, SDOH, and study design/phase/theme. The framework for health disparities research by Kilbourne (2006) was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Themes were categorized based on the National Institute of Health American College of Surgeons (NIH-ACS) Summit on Surgical Disparities: clinician factors, patient factors, systemic/access factors, clinical quality factors, and postoperative care and rehabilitation-related factors. Descriptive analysis and study trends were assessed.
Results: The initial search yielded 446 articles and 48 articles were included in final analysis. Of studies assessing one SDOH, the three most studied were insurance status (n=13;32.5%), health literacy (n=10;25%), and social deprivation (n=6;15%). Of studies assessing one disease/injury, the three most studied were carpal tunnel (n=9;18.8%), upper extremity trauma (n=9;18.8%), and amputation (n=5;10.4%). Regarding ACS themes, most studies assessed patient factors (n=31;57.4%) and systemic/access factors (n=15;27.8%), while few assessed clinical quality factors (n=4;7.4%), clinician factors (n=3;5.6%), and post-operative/rehabilitation-related factors (n=1;1.9%). Most studies had retrospective or database designs (n=28;58.4%). Studies identifying and analyzing risk factors comprised 87.5% of the studies (detecting phase=62.5%; understanding phase=25%). Only 6 (12.5%) were in the reducing phase assessing interventions.
Conclusions: Despite an encouraging upward trends in health disparities research, existing studies are in the early phases of investigation (detecting/understanding). Most studies relied on retrospective review and databases, while few were prospective, cross-sectional, or mixed-methods. Furthermore, few studies examined access to postoperative rehabilitation, which are vital for patient recovery especially in the setting of traumatic injury. Further work is needed to better understand social factors contributing to poor hand surgery outcomes and inform future interventions.



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