gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Effect of Insurance Status on Rate of Operative vs. Non-operative Management of Clavicle Fractures

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  • presenting/speaker Dominick Congiusta - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Kamil Amer - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Aziz Merchant - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Michael Vosbikian - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Irfan Ahmed - Rutgers New Jersey Medical School, Newark, New Jersey, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1356

doi: 10.3205/19ifssh0174, urn:nbn:de:0183-19ifssh01744

Published: February 6, 2020

© 2020 Congiusta et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: The majority of closed clavicle fractures are treated non-operatively. Recent literature has reported differences in the treatment of clavicle fractures based on insurance status in America [1]. Such research has socioeconomic implications and may highlight discrepancies in healthcare delivery. We aimed to conduct the first analysis of a national database, representative of the entire United States, to identify any associations with insurance status and rate of operative fixation of clavicle fractures.

Methods: The Nationwide Inpatient Sample database (NIS) 2001-2013 was queried for closed clavicle fractures using the International Classification of Diseases, 9th Revision (ICD-9) diagnostic codes. Surgical intervention was determined by using ICD-9 procedural codes. Chi square analysis was performed to determine significant predictors of operative intervention. Multivariate logistic regression was then used to account for demographic and other significant variables. Results were recorded as odds ratios (OR) and 95% confidence intervals (95% CI), and significance was defined as p<0.05.

Results and Conclusions: A total of 76,470 inpatients with clavicle fractures were included in the final analysis. Rate of clavicle surgery was 8.6% (n=6,539). Multivariate analysis revealed that having private insurance was predictive of operative fixation (OR 1.55 [95% CI 1.44-1.67]) compared to non-private insurance (p< 0.01). In addition, age >60 years, female sex, Caucasian race, elective admissions, use of emergency services, and fractures of the shaft were significantly associated with operative fixation (p<0.01).

Having private insurance is independently predictive of undergoing operative fixation of clavicle fractures. While we identify different in rates of surgery, this does not necessarily indicate a disparity in care. We highlight a socioeconomic factor that may play a role in patient education and utilization of healthcare resources.

Table 1 [Tab. 1], Table 2 [Tab. 2]

Outline

References

1.
Schairer WW, Nwachukwu BU, Warren RF, Dines DM, Gulotta LV. Operative Fixation for Clavicle Fractures-Socioeconomic Differences Persist Despite Overall Population Increases in Utilization. J Orthop Trauma. 2017 Jun;31(6):e167-e172.