The Association of Social Determinants of Health and Patient-Reported Outcomes In Patients with Surgical Treatment of Osteochondral Lesion of the Talus

Abstract

Category: Ankle; Sports Introduction/Purpose: Osteochondral lesions of the talus (OLT) commonly arise after chronic ankle sprains and fractures. Conservative treatment is the first step, yet surgical intervention is often warranted in patients with persistent symptoms. The effect of social determinants of health (SDOH) on treatment outcomes of this patient population has rarely been investigated to date. Methods: Patients with OLT who were 18 years of age and older and underwent operative treatment, with at least one patient-reported outcome and SDOH data available, were included. Patient-Reported Outcome Measures (PROMs) and Visual Analog Scale (VAS) pain scores were collected, and their trends were analyzed based on the patients’ SDOH, including Area DeprivationIndex(ADI)andSocialVulnerabilityIndex(SVI). Pre-operativePROMsorVAS pain scores had to have been collected within 90 days of surgery, immediate post-operative PROMs or VAS scores were recorded within 90 days of surgery were and post-operative PROMs or VAS scores within 180 days (± 30 days). Exclusion criteria were presence of concomitant pathologies such as fractures, bone lesions, cysts, foot and ankle deformities, presence of hardware, and lack of follow-up visits and lack of any patient reported outcomes in their profile. A P-value < 0.5 was considered statistically significant. Results: 109 of 551 confirmed patients with OLT met the inclusion criteria. Significant correlations were found between SDOH and PROMs, elucidating disparities in pain scores, physical function, and depression. A multitude of SVI components, but most profoundly overall SVI, and ADI rank, were found to be significantly correlated to VAS pain scores (Table 1.). Furthermore, insurance status showed a significant impact on pain intensity and depression measures. Nuanced influences of race, insurance status, and social vulnerability were observed. Conclusion: This study shows that SDOH have a significant effect on postoperative PROMs and VAS scores. Based on our results, these most prominently include overall SVI, insurance status, ethnicity, and race. Systemic interventions guided by neighborhood-level measures of disadvantage are key in advancing health equity.