Effect of Ethnicity and Child Opportunity Index on Glenohumeral Labral Repair Postoperative Physical Therapy Attendance in Adolescents.

Abstract

Background: Recovery from orthopaedic surgery in the adolescent population can be complicated by socioeconomic barriers and known health care disparities prevalent among racial/ethnic groups. Such barriers can negatively affect patient outcomes, particularly if accessibility to postoperative physical therapy (PT) is affected.

Purpose: To determine the effect of race, ethnicity, language spoken, or Child Opportunity Index (COI) on recovery from glenohumeral labral repair in the pediatric population.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent glenohumeral labral repair at a single center between September 2009 and December 2018 were reviewed. The inclusion criteria were pre- and postoperative data available at the time of chart review, with a minimum of 2 postoperative appointments with the surgeon. Charts were reviewed to gather demographic and clinical data, including age, sex, race, ethnicity, pre- and postoperative visits with the surgeon, and PT data. Cohorts of Hispanic or Latino (HL) and non-Hispanic (NH) were analyzed along with COI classification levels and outcomes.

Results: A total of 132 patients met the inclusion criteria-61(46%) women and 40 (30%) HL patients-with a mean age of 15.5 years. There was no difference between HL and NH patients regarding the time from injury to initial visit, the time from initial visit to surgery, and the number of postoperative clinic visits with the surgeon (P > .05). The NH cohort had more PT sessions completed postoperatively (24 sessions) than the HL cohort (19 sessions) (P = .024). There was a significant difference in the rate of PT cancellations based on COI, with the high and very high opportunity groups having the most cancellations (P = .029). When COI was added as a covariate, no differences were observed based on ethnicity regarding any of the outcome variables (P > .05).

Conclusion: Ethnicity appears to independently factor into postoperative PT session attendance. Patients living in areas with the highest opportunity index had higher rates of postoperative PT cancellations. Future studies should focus on longer-term outcomes, rather than the ability to attend postoperative PT, to further identify whether ethnicity is truly a factor for any discrepancies in health care related to glenolabral repair in the pediatric population.