Increasing surgical rate of clavicle fractures and acromioclavicular dislocations in Chile: analysis over the last 15 years reveals disparities in access according to insurance type.

Abstract

Background: In recent years, an increase in surgeries to treat clavicle injuries has been reported. It has been hypothesized that the studies regarding the beneficial effect of surgery in patients with displaced clavicle fractures may have contributed to raise the surgical rates for injuries around the clavicle. To our knowledge, there is a lack of data from Latin American countries on surgical rates of clavicle-related surgeries. The aim of this study is to describe the rate of clavicle surgeries, including clavicle fracture and acromioclavicular dislocation, in the last 15 years and to analyze the possible effect of sex, age, and health insurance in those rates.

Methods: An observational cross-sectional study was carried out. Patients over 18 years old diagnosed with the following ICD-10 codes were selected: S420 "Clavicle fracture", S431 "Dislocation of the acromioclavicular joint", and S435 "Sprains and strains of the acromioclavicular joint". We collected information on the year of surgery, sex, age and type of insurance. The annual rate of surgeries and the rate for the period studied per 100,000 people were calculated. The rate was compared through negative binomial regression, reporting Incidence Rate Ratios (IRR) with 95% confidence interval (95% CI).

Results: During a 15 years period of observation, 24,570 surgeries were performed. For clavicle fractures an 8.0 × 100,000 surgical rate was observed, and a 4.7 × 100,000 rate was found for acromioclavicular dislocations. The surgical rate for clavicular injuries increased from 2.8 in 2005 to 19.1 in 2019. Rates were higher in men, and ages between 20 and 35 years. The surgical rate for clavicular injuries in the public system was 11.1 × 100,000 and 30.9 × 100,000 in the private system, which represents a difference of 2.8 times between those healthcare systems.

Conclusion: There has been a significant increase in clavicle and acromioclavicular dislocation surgeries in Chile, with disparities influenced by age, gender, and type of health insurance.