Do insurance and socioeconomic status affect outcomes for children who undergo surgery for medial epicondyle fractures?

Abstract

Background: Low socioeconomic status (SES) and Medicaid insurance have been associated with poorer outcomes. The purpose of this study is to compare outcomes among children with Medicaid vs private insurance, and children with low vs high SES who undergo surgery for medial epicondyle fractures. Methods: This is a retrospective review of patients who underwent surgery for medial epicondyle fractures at a large pediatric hospital between 2015 and 2020. SES was measured using the Opportunity Atlas and the United States Small-Area Life Expectancy Estimate Project. A subset of patients were prospectively administered the PROMIS Pediatric Pain Intensity Numeric Rating Scale and PROMIS Pediatric Upper Extremity Short Form to gather additional information on outcomes as they relate to SES. Results: Of 117 patients, 59 (50.4%) were females, 90 (76.9%) were Caucasian, and average age was 11.1. The average household income was $44,889 (SD=$11,417) and most patients (72.6%) were privately insured. Higher household income was associated with increased number of follow-up appointments (β=0.29, 95% CI=0.08, 0.50) and increased likelihood of using physical therapy (OR=1.67, 95% CI=1.15, 2.42). Patients with private insurance returned to activity 20.5 days sooner than those with public insurance (β=−20.52, 95% CI=−39.5, −1.53). Private insurance tended to be related to less likelihood of complications and more likelihood of use of physical therapy. Conclusions: Insurance and SES may play a role in shaping healthcare outcomes for pediatric patients receiving surgery for medial epicondyle fractures. Level of Evidence: Prognostic Level III.