Summary

This retrospective chart review identified gender and primary insurance coverage among other social determinants of health that appear to influence postoperative complications following arthroscopic Bankart repair.

Abstract

Objectives:
It is well documented that social determinants of health (SDOH) impact outcomes following orthopaedic surgery procedures. However, there is a paucity of literature regarding how the presence of SDOHs impact outcomes following arthroscopic Bankart repair. The purpose of this study was to investigate and identify SDOHs that have the greatest impact on postoperative complications following arthroscopic Bankart repair for recurrent shoulder instability.

Methods

In March 2024, a retrospective chart review was conducted on patients from a single institution. Eligible patients were identified using EPIC database. Patients who underwent arthroscopic Bankart repair between 2010 and 2023 at the corresponding authors’ institution were included. Data collected included patient age, gender, race, ethnicity, primary insurance coverage type, past medical and surgical history, and operative reports. Complication status (yes/no) was defined as: recurrent instability, revision or additional shoulder surgery, hardware failure, infection and/or pain (when requiring an additional procedure). Median household income (HHI) data was gathered from external census data, and then cross-referenced with patients’ residential ZIP Codes to extrapolate an estimated HHI. Chi-squared tests for independence were used to evaluate the effects of gender, race, and insurance type on complications. A Welch’s t-test was performed to compare median household income corresponding to the patient's zip codes and complications.

Results

A total of 364 shoulders were included in analysis representing 360 patients, of which 116 were female (32%) and 244 were male (68%). There was a total of 98 (26.9%) complications. Females experienced more complications than males (?21=5.8, P=.016) with an OR of 1.80 (95% CI 1.11-2.91). Similarly, non-commercially insured patients experienced greater complication rates (?21=7.6, P=.006) with an OR of 1.92 (95% CI 1.20-3.07). Race (?22=0.3, P=.219) and HHI (t206.15=-1.3, P=0.028) were independent from complications.

Conclusion

This retrospective chart review identified several social determinants of health that appear to be associated with postoperative complications following arthroscopic Bankart repair. Analysis of results found that patients with non-commercial insurance coverage and female gender were associated with an increased risk of postoperative complications. Further research is necessary to gain a better understanding of the impact SDOHs have on arthroscopic Bankart repairs and is essential to the field of orthopaedic surgery, to both properly treat patients and provide necessary resources to improve outcomes.