Time to surgical management of distal radius fractures: effects on healthcare utilization and functional outcomes
Kathy Liu, MPH, MD1, Emma J.M. Grigor, MSc, MD(c)2, Daniel Antflek, BSc1, George Ho, MD3, Heather L Baltzer, MSc, MD, FRCSC1 and Ryan Paul, M.D. FRCSC1, (1)University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, (2)University of Ottawa, Ottawa, ON, Canada, (3)University of Toronto, Toronto, ON, Canada
This study investigates the association between delayed time to surgery (TTS) and healthcare utilization, and functional outcomes in patients undergoing open reduction and internal fixation (ORIF) for isolated acute distal radius fractures (DRFs) with a volar locking plate. Secondarily, this study aimed to understand what factors may influence a delayed TTS.
Materials & Methods
A 10-year, single center, retrospective chart review of patients who underwent ORIF for isolated acute DRFs from 2009 to 2019 was conducted. TTS was the primary outcome of interest, which was grouped as early TTS (â‰¤ 14 days) and delayed TTS (> 14 days). Chi-square (or Fisher exact) and Wilcoxon rank sum (or Kruskal Wallis) tests were performed to provide statistical comparison of TTS by healthcare utilization and functional outcomes. Univariable and multivariable logistic regression analyses were performed to identify factors significantly associated with TTS. All significant univariables were included in the multivariable logistic regression model, which identified factors based on significant adjusted odds ratios (95% CI excluding the null) after adjusting for confounding variables. Pâ€“value <0.05 indicated statistical significance.
106 patients were included with 36(34.0%) patients in the early TTS group and 70(66.0%) patients in the delayed TTS group. Healthcare utilization analysis showed a statistically higher mean number of preoperative clinic visits in patients with delayed TTS compared to early TTS [3.34(±0.961) vs. 2.74(±0.790), p<0.001], as well as a significantly higher mean number of postoperative hand therapy appointments [12.5(±11.9) vs. 8.09(±5.92), p=0.028]. The functional outcome analysis revealed significantly lower wrist flexion in patients with delayed TTS compared to early TTS [42.7(±18.9) vs. 52.2(±19.1), p=0.021] at the first follow-up visit postoperatively. The multivariable model showed that the higher estimated income group (>$39,405 per annum) had 0.377-times lower odds of delayed TTS compared to the lower estimated income group ($39,405 or less) (95% CI: 0.125, 0.701; p=0.006), after adjusting for DRF laterality (p>0.05).
In this study, delayed ORIF for DRFs beyond 14 days was associated with greater healthcare utilization (number of preoperative clinic visits and postoperative hand therapy sessions). Patients in the delayed treatment group demonstrated lower wrist flexion at their first follow-up visit, but this difference did not persist to their final follow-up. Patient income could be an influential factor between early versus delayed surgery and warrants further evaluation regarding equitable access to care.
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