ArticleOrthopaedic journal of sports medicine2026
The Impact of Social Determinants of Health on Complications and Health Care Utilization After Tibial Tubercle Osteotomy.
Article in Orthopaedic journal of sports medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Social determinants of health disparities (SDHD), encompassing environmental, health care, social, educational, and economic factors, are known to increase the risk of complications after various orthopaedic procedures. However, their impact on tibial tubercle osteotomy (TTO) outcomes remains undefined. Hypothesis/Purpose: This study aimed to compare complication risks and health care utilization within 90 days and 1 year of primary TTO in patients with versus without SDHD. It was hypothesized that SDHD patients would show higher odds of health care utilization and complications. Study Design: Cohort study; Level of evidence, 3. Methods: Adult (>17 years) patients who underwent primary TTO from January 2010 to April 2023 were identified using the PearlDiver M170 database. The exclusion criteria included inactivity within 90 days after TTO or a history of neoplasm or infection within 90 days before the procedure. The overall cohort was divided into SDHD and non-SDHD groups. Patient characteristics-including age, sex, Elixhauser Comorbidity Index, obesity, type 2 diabetes mellitus, tobacco or nicotine use, and substance use disorder-were abstracted. Patients without versus with SDHD were matched (2:1) based on all demographic variables. Moreover, 90-day and 1-year complications were identified and compared using the Pearson chi-square test and multivariable logistic regression, adjusted for demographic variables. Results: Of 11,419 overall patients, 1333 patients (11.7%) had SDHD. After matching, 736 SDHD and 1375 non-SDHD patients were analyzed. On multivariable analysis, SDHD was associated with increased odds of 90-day readmission (odds ratio [OR], 3.71 [95% CI, 2.22-6.37]), urinary tract infection (UTI) (OR, 3.11 [95% CI, 1.96-5.01]), emergency department (ED) visit (OR, 2.22 [95% CI, 1.78-2.76]), and venous thromboembolism (VTE) (OR, 1.85 [95% CI, 1-3.44]). At 1 year, SDHD patients demonstrated higher odds of revision TTO (OR, 8.10 [95% CI, 2.95-33.44]) and nonunion (OR, 2.05 [95% CI, 1.03-4.13]) (all Conclusion: The present study found that SDHD patients were associated with increased odds of ED visits, readmissions, VTE, and UTI after primary TTO. Additionally, SDHD patients demonstrated higher odds of revision TTO and nonunion. Further research is needed to identify the root causes of these differences, enabling targeted strategies to reduce future outcome inequities associated with SDHD.
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