Does Area Deprivation Index Predict Worse Initial Preoperative Patient-Reported Outcomes in Patients Who Underwent Microfracture for Osteochondral Lesions of the Talus?
Authors: Austin Warren , Cotton Kenzo M. , Findlay Garcia , Umanes Marfred Munoz , Smith Richard Michael , Brown Cortes , Austin Warren , Lewis Lauren , Cain Jarrett D. , Hogan Macalus V. 
Published: December 2024

Category: Ankle; Arthroscopy Introduction/Purpose: The relationship between socio-economic factors and health outcomes is of considerable interest. Social deprivation can be defined as lack of access to resources and opportunities considered essential for modern living. Several studies have investigated the impact of social deprivation on surgical outcomes. Patients who experience more social deprivation may have an initial presentation that is objectively worse compared to patients with a higher socioeconomic status. For example, socially deprived scoliosis patients may initially present with larger Cobb angles. Limited literature on the impact of social deprivation on initial presentation of patients who require surgical intervention for an osteochondral lesion (OCL) of the talus exists. This study aimed to investigate the association between social deprivation and preoperative patient-reported outcomes. Methods: Institutional review board approval was obtained (IRB 20020136). An institution-based registry was created with foot and ankle patient data from three surgeons that were prospectively collected and retrospectively analyzed. The database was queried for patients who underwent talar dome OCL microfracture and completed preoperative Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL) questionnaires between September 2013 and February 2024. Home addresses were used to determine Area Deprivation Index (ADI) state and national levels to capture social deprivation. Inclusion criteria were patients with an OCL diagnosed with advanced imaging and patients with completed preoperative FAAM ADL scores. Patients with prior ipsilateral foot or ankle surgeries or no recorded home address were excluded. Linear regression and correlation analyses were performed to investigate the relationship between ADI and preoperative FAAM ADL scores. Secondary analyses on the impact of ADI on other clinical variables were performed. Results: Sixty patients met inclusion criteria. The mean age was 32.5±15.2 years with a mean body mass index (BMI) of 29.8±7.58, evenly split between sexes. The mean preoperative FAAM ADL score as 62.4±23.5. Differences between female and male preoperative FAAM ADL scores reached significance (55.7 vs. 69.2, p = 0.026). The regression coefficient for ADI and preoperative FAAM ADL scores at the national (adjusted R2 = 0.005, p = 0.262) and state (adjusted R2 = 0.017, p = 0.160) levels failed to reach significance. Mean national ADI was 53.4±26.2 and state ADI was 4.97±2.87. Correlation analysis of other clinical variables studied, such as OCL size (p = 0.668) and BMI (p = 0.1316), did not demonstrate a statistically significant correlation with ADI. Conclusion: These findings contribute to the data regarding the interplay between socio-economic factors and health outcomes, particularly in the context of patients who underwent microfracture for a talus OCL. Larger sample sizes and including patients who opted for nonoperative treatment should be explored.