Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review
Category: Ankle Arthritis; Ankle Introduction/Purpose: Social determinants of health (SDOH) encompass environmental, institutional, and intrinsic conditions that can influence an individual's access to and utilization of healthcare over their lifespan. While SDOH effects are linked to dispariti...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-12-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011424S00503 |
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| author | James J. Butler MB BCh BAO Megan Calton BS Amit Manjunath MD Amanda Mener MD, PhD Andrew Rosenbaum MD Michael Mulligan MD Alan P. Samsonov BS John G. Kennedy MD, MCh, MMSc, FFSEM, FRCS (Orth) |
| author_facet | James J. Butler MB BCh BAO Megan Calton BS Amit Manjunath MD Amanda Mener MD, PhD Andrew Rosenbaum MD Michael Mulligan MD Alan P. Samsonov BS John G. Kennedy MD, MCh, MMSc, FFSEM, FRCS (Orth) |
| author_sort | James J. Butler MB BCh BAO |
| collection | DOAJ |
| description | Category: Ankle Arthritis; Ankle Introduction/Purpose: Social determinants of health (SDOH) encompass environmental, institutional, and intrinsic conditions that can influence an individual's access to and utilization of healthcare over their lifespan. While SDOH effects are linked to disparities in patient-reported outcomes post hip and knee arthroplasty, their impact on total ankle arthroplasty (TAA) remains unclear. This study sought to examine how SDOH factors affect access to appropriate orthopedic treatment and their repercussions on patient-reported outcomes following TAA. Methods: In January 2024, a systematic review of the PubMed, Embase and the Cochrane Library was conducted to identify studies reporting at least 1 SDOH and its effect on access to health care, clinical outcomes, or patient-reported outcomes following TAA. Results: Fifty-eight studies, involving 212,944 patients, were analyzed. The INBONE system emerged as the most utilized Total Ankle Arthroplasty (TAA) system. Factors contributing to healthcare access delays included female gender, advanced age, worker's compensation claims, comorbidities, tobacco use, federally subsidized insurance, lower education, racial/ethnic minority status, low-income residence, low-volume surgery regions, unemployment, and preoperative narcotic use. Black patients experienced significantly worse postoperative clinical and patient-reported outcomes, along with heightened pain following TAA. Lower education level independently predicted poor surgical and patient-reported outcomes, increased pain, and lower patient satisfaction. Moreover, patients with federally subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes. Conclusion: The impediments created by SDOH lead to worse clinical and patient-reported outcomes following TAA including increased risk of postoperative complications, TAA failure, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR. |
| format | Article |
| id | doaj-art-e2c424ac93e0499fb5e7b214bccfb21e |
| institution | Kabale University |
| issn | 2473-0114 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj-art-e2c424ac93e0499fb5e7b214bccfb21e2024-12-30T08:03:35ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-12-01910.1177/2473011424S00503Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic ReviewJames J. Butler MB BCh BAOMegan Calton BSAmit Manjunath MDAmanda Mener MD, PhDAndrew Rosenbaum MDMichael Mulligan MDAlan P. Samsonov BSJohn G. Kennedy MD, MCh, MMSc, FFSEM, FRCS (Orth)Category: Ankle Arthritis; Ankle Introduction/Purpose: Social determinants of health (SDOH) encompass environmental, institutional, and intrinsic conditions that can influence an individual's access to and utilization of healthcare over their lifespan. While SDOH effects are linked to disparities in patient-reported outcomes post hip and knee arthroplasty, their impact on total ankle arthroplasty (TAA) remains unclear. This study sought to examine how SDOH factors affect access to appropriate orthopedic treatment and their repercussions on patient-reported outcomes following TAA. Methods: In January 2024, a systematic review of the PubMed, Embase and the Cochrane Library was conducted to identify studies reporting at least 1 SDOH and its effect on access to health care, clinical outcomes, or patient-reported outcomes following TAA. Results: Fifty-eight studies, involving 212,944 patients, were analyzed. The INBONE system emerged as the most utilized Total Ankle Arthroplasty (TAA) system. Factors contributing to healthcare access delays included female gender, advanced age, worker's compensation claims, comorbidities, tobacco use, federally subsidized insurance, lower education, racial/ethnic minority status, low-income residence, low-volume surgery regions, unemployment, and preoperative narcotic use. Black patients experienced significantly worse postoperative clinical and patient-reported outcomes, along with heightened pain following TAA. Lower education level independently predicted poor surgical and patient-reported outcomes, increased pain, and lower patient satisfaction. Moreover, patients with federally subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes. Conclusion: The impediments created by SDOH lead to worse clinical and patient-reported outcomes following TAA including increased risk of postoperative complications, TAA failure, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.https://doi.org/10.1177/2473011424S00503 |
| spellingShingle | James J. Butler MB BCh BAO Megan Calton BS Amit Manjunath MD Amanda Mener MD, PhD Andrew Rosenbaum MD Michael Mulligan MD Alan P. Samsonov BS John G. Kennedy MD, MCh, MMSc, FFSEM, FRCS (Orth) Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review Foot & Ankle Orthopaedics |
| title | Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review |
| title_full | Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review |
| title_fullStr | Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review |
| title_full_unstemmed | Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review |
| title_short | Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review |
| title_sort | social determinants of health influence clinical outcomes of patients undergoing total ankle arthroplasty a systematic review |
| url | https://doi.org/10.1177/2473011424S00503 |
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