The Influence of Patient Characteristics and Social Determinants of Health on Post-Operative Complications Following Achilles Tendon Ruptures
Authors: Hendriks Joris R.H , Baker Riley J. , Lucaciu Andreea R. , Lans Amanda , Kerkhoffs Gino M.M.J. , Ashkani-Esfahani Soheil , DiGiovanni Christopher W. , Guss Daniel 
Published: December 2023

Category:

Sports; Hindfoot

Introduction/Purpose:

While patient comorbidities are known to affect surgical complication rates after Achilles tendon rupture (ATR) repair, the correlation between social determinants of health (SDH) and postoperative complication rates is poorly understood. Two validated indices representative of SDH include the Area Deprivation Index (ADI), which ranks neighborhoods by social disadvantage, and the Social Vulnerability Index (SVI), which uses 16 US census variables to identify communities at risk before or after natural disasters. In this study, we aim to determine whether there is any correlation between patient demographics, SDH, and postoperative complication rates following surgical treatment of ATR.

Methods:

A retrospective chart review identified 521 patients who underwent surgical repair of an acute ATR between 2015 and 2021. Inclusion criteria included age ≥ 18 years, a minimum 30 day follow up, and patients who underwent acute repair within 28 days of ATR. Collected variables included patient demographics, time to surgery (TTS), injury characteristics, and postoperative complications sub-categorized into venous thromboembolism (VTE), re-rupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included age, race, smoking status, insurance status, level of education, and employment status. The ADI and SVI measurements of patient deprivation or vulnerability were also extracted from the data. A univariate regression test was performed to determine the correlation between each complication and each SDH indicator. Variables that showed significance (p < 0.05) were then included in a multivariate regression to determine the correlation coefficients and significance.

Results:

Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed higher ADI was associated with VTE occurrence (OR = 0.39, 95% CI: 0.16 –0.91, p = 0.03). Female patients and open surgical approach correlated with decreased VTE occurrence (OR = 0.24, 95% CI: 0.09 – 0.66, p< 0.01), (OR = 0.15, 95% CI: 0.04 – 0.55, p< 0.01), respectively. Higher BMI was associated with VTE (OR = 1.62, 95% CI: 1.05 – 2.51, p=0.03) and re-rupture (OR = 3.86, 95% CI: 1.51 – 9.08, p< 0.01). Women experienced decreased wound dehiscence rates (OR = 0.25, 95% CI: 0.09 – 0.69, p< 0.01) and SSI (OR = 0.31, 95% CI: 0.11 – 0.93, p=0.04) compared to men. TTS correlated with sural nerve injuries (OR=2.09, 95% CI: 1.32 – 3.31, p< 0.01).

Conclusion:

This study found that SDH, such as ADI, impacts complication rates after ATR repair, though the nature of this relationship remains unclear. Patient demographic and anthropometric factors such as gender and BMI also have an impact. Future studies should include a larger, more diverse sample population to better understand the impact of these factors on surgical outcomes.