Higher complication rates after management of lower extremity fractures in lower socioeconomic classes: Are risk adjustment models necessary?

Introduction Alternative payment models, such as bundled payments, have been proposed to control rising costs in orthopaedic trauma surgery. Without risk adjustment models, concerns exist about the financial burden incurred by so called “safety-net hospitals” that serve patients of lower socioeconom...

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Bibliographic Details
Published in:Trauma (London, England) England), 2022-04, Vol.24 (2), p.131-137
Main Authors: Henstenburg, Jeffrey M, Lieber, Alexander M, Boniello, Anthony J, Kerbel, Yehuda E, Shah, Mitesh
Format: Article
Language:English
Subjects:
Capitation
Complications
Demographics
Demography
Femur
Fractures
Income
Length of stay
Mortality
Orthopedics
Patients
Quartiles
Regression analysis
Resource utilization
Risk
Socioeconomic factors
Socioeconomics
Tibia
Trauma
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Summary:Introduction Alternative payment models, such as bundled payments, have been proposed to control rising costs in orthopaedic trauma surgery. Without risk adjustment models, concerns exist about the financial burden incurred by so called “safety-net hospitals” that serve patients of lower socioeconomic status. The purpose of this study was to determine whether lower socioeconomic status was associated with increased complications and subsequently higher resource utilization following surgical treatment of high-energy lower extremity fractures. Methods The National Inpatient Sample database was queried for patients who underwent surgical fixation of the femur and tibia between 2005–2014. The top and bottom income quartiles were compared. Demographics, medical comorbidities, length of stay (LOS), complications, in-hospital mortality were compared between patients of top and bottom income quartiles. Multivariate logistic regression analysis was then performed to identify factors independently associated with complications, mortality, and increased resource utilization. Results Patients with femur fracture in the bottom income quartile had longer length of stay (6.9 days vs 6.5 days, p 
ISSN:1460-4086
1477-0350
DOI:10.1177/1460408620975693