Is Area Deprivation Index Associated With Delays in Surgical Treatment of Acute Scaphoid Fractures?

Abstract

Background:

Social determinants of health greatly influence medical outcomes. The Area Deprivation Index (ADI) assesses socioeconomic disparities. This study evaluates the impact of geographic socioeconomic disadvantage on the time to scaphoid open reduction and internal fixation (ORIF).

Methods:

A retrospective chart review from 2012 to 2023 analyzed time to surgery (TTS) with 21- and 28-day cutoffs (TTS₂₁ and TTS₂₈). Patients were categorized into highest (ADI_high) and lowest (ADI_low) national ADI quartiles. Logistic regression and proportional hazards models were built to determine whether ADI status affected time to surgery. The impact of age, sex, race, ethnicity, insurance status, and medical comorbidities on TTS was also assessed.

Results:

Among 116 patients (83% male, 17% female), the average TTS was 20.8 ± 27.1 days. For TTS₂₁, mean TTS_≤21 was 8.9 ± 5.2 days versus TTS_>21 was 52.1 ± 35.3 days (P < .05). For TTS₂₈, mean TTS_≤28 was 10.5 ± 6.9 days versus TTS_>28 was 62.7 ± 36.6 days (P < .05). ADI_low and ADI_high quartiles had 30 patients each, with average TTS of 23.1 ± 34.3 and 19.3 ± 25.0 days, respectively, with no significant difference (P = .18).

Conclusion:

Significant surgical delays occur when scaphoid ORIF is performed after 21- or 28-day post-injury. Although geographic disadvantage was not identified as a risk in this study due to small sample size, future studies could help clarify the utility in ADI integration into electronic records to identify at-risk patients for more timely surgical intervention.