Racial, Socioeconomic, and Demographic Disparities in the Management of Meniscal Tears (179)

OBJECTIVES: Meniscal surgery, repair or debridement, makes up about a third of all arthroscopic related surgery. In the adult population, there is much debate about which patients should undergo surgical intervention and which should be treated nonoperatively. There seems to be a paucity of literature related to how a patient’s demographics, insurance status, socioeconomic status, and race impact the likelihood of undergoing surgical intervention. In the present study, we sought to determine how these factors influence whether a patient undergoes surgical intervention following a meniscal injury. METHODS: From 2009-2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary meniscus injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. ICD 9/10 CM codes were used to identify the initial diagnosis for each patient. ICD9/10 PCS and Current Procedural Terminology (CPT) codes were used to identify subsequent meniscus surgery. The procedures identified were linked with the initial diagnosis and patients were noted as either having meniscus surgery, or not having meniscus surgery. After missing data was removed, logistic regression analysis was performed to determine the effect of patient factors on the likelihood of having surgery after a diagnosis of meniscus injury. RESULTS: Of 394,007 adult meniscus injury diagnoses, 84.7% proceeded to undergo surgical intervention. The median age for no surgery was 51 (mean: 49.4) and the median age for surgery was 52 (mean: 50.2) (p<.0001) (Table 1). Females relative to males (OR=0.757, p<.0001), increased social deprivation index (SDI) (OR=0.994, p<.0001), African American compared to white race (OR=0.822, p<.0001), hispanic relative to non-hispanic ethnicity (OR=0.682, p<.0001), federal relative to private insurance (OR=0.459, p<.0001), and self-pay relative to private insurance (OR=0.437, p<.0001) were all associated with decreased odds of undergoing meniscus surgery. Older patients (OR=1.009, p<.0001), worker’s compensation relative to private insurance (OR=1.284, p<.0001) and patients with a charlson comorbidity index (CCI) score ≥1 had increased odds of undergoing surgery (OR=1.129, p<.0001) (Table 2). CONCLUSIONS: Multiple demographic, insurance status, socioeconomic status, and race factors influence the decision to manage meniscal tears surgically. Females, those with increased social deprivation index, African-Americans, Hispanics, or those with federal insurance or self-pay (when compared to private insurance) were less likely to undergo surgical intervention for meniscal tears. Those with workers’ compensation, who were of older age and higher CCI were more likely to undergo surgical intervention. Further research is ultimately needed to elicit causes for disparities between demographic groups.