The Association Between Distressed Community Index and Clinical Outcomes Following Surgical Repair of Acute Achilles Tendon Rupture
Authors: Kim C. James , Tsai Justin , Pedowitz David I. , Fuchs Daniel , O’Neil Joseph T. , Shakked Rachel , Winters Brian S. , Daniel Joe 
Published: December 2023

Category:

Ankle; Other

Introduction/Purpose:

Operative management of acute Achilles tendon ruptures can be associated with a myriad of complications1,2. Demographics and comorbidities have been previously explored in relation to outcomes after operative management of Achilles tendon ruptures3,4. However, the relationship between socioeconomic factors and postoperative outcomes in these patients has not been explored. Distressed community index (DCI) is a score that represents a community’s level of well-being across the United States, with higher scores representing greater distress experienced in the community. Independent socioeconomic deprivation factors have been shown to be associated with suboptimal postoperative outcomes for patients undergoing certain orthopedic surgeries6–9. The purpose of this study is to determine if there is any association between DCI scores and short-term complication rates and functional outcomes following ruptured Achilles tendon repair.

Methods:

Patients who underwent surgical repair of ruptured Achilles tendon between 2015 and 2019 were identified. Patients’ residence zip codes were obtained and matched to corresponding DCI scores (0-100) based on data provided by the Economic Innovation Group for the same time period (2015-2019). Scores were divided into quintiles. Patient age, race, ethnicity, alcohol and smoking history, need for assistance with activities of daily living, ambulation status unrelated to injury, and access to transportation were also noted. Complications such as re-rupture, superficial or deep infection, wound complications, and deep vein thrombosis within 1-year since date of surgery were noted. Preoperative Foot and Ankle Ability Measure and Visual Analogy Pain scales were compared to postoperative scores at 6 months, 1 year, and 2 years. Analysis of variance (ANOVA) was used to determine the statistical significance of differences in the rate of complications and FAAM-VAS scores between quintiles.

Results:

Patients in the 2nd DCI quintile experienced the highest rate (9.25%) of total complications while patients in the 5th quintile experienced the lowest rate (3.33%). Difference in complication rates across DCI quintiles was not statistically significant (p=0.925). Out of the 17 patients who experienced complications, 12 (70.6%) patients belonged to the 1st and 2nd quintile while 2 patients (11.7%) belonged to the 4th and 5th quintiles. The differences in FAAM and VAS pain scores were not significantly different at preoperative and at 1-year and 2-year postoperative time points across quintiles. However, patients in the 5th and 4th quintiles experienced the greatest improvement in FAAM Overall scores at 1-year and 2-year postoperative time points, respectively.

Conclusion:

Patients living in more distressed communities did not experience greater postoperative complication rates or report lower patient-reported outcomes up to 2 years following operative repair of Achilles tendon rupture.