Higher Distressed Communities Index is Associated With Loss to Follow-up Within 6 Months of Ankle Fracture Surgery

Background: The Distressed Communities Index (DCI) is a metric often used in the assessment of health care disparities. The purpose of this study was to investigate whether DCI correlates with aspects of presentation, clinical course, and postoperative events among adult ankle fracture patients who undergo surgical repair. Materials and Methods: This retrospective cohort study included adult ankle fracture patients who underwent primary ankle open reduction internal fixation (ORIF) between August 2015 and June 2023 at a single academic tertiary-care center. Patients were separated into two DCI cohorts determined by ZIP Codes: more distressed (DCI≥75) and less distressed (DCI<75). Primary outcomes were time to presentation and time to definitive surgery. Secondary outcomes including location of presentation, admission rates, length of stay, postoperative complications (eg, infection, hardware failure, reoperation), physical therapy participation, and loss to follow-up were also assessed. Results: A total of 940 patients were included. No differences were observed in time to presentation or time to definitive surgery. However, patients from more distressed communities were more likely to be lost to follow-up during the first 6 months following ankle ORIF compared to those from less distressed communities (95% CI, 1.15-2.67). No differences were found with respect to other secondary outcomes. Conclusions: Higher DCI is associated with loss to follow-up within the 6 months following ankle fracture ORIF. Interventions focused on uncovering and addressing reasons for loss to follow-up among patients from distressed communities may help ensure follow-up completion during the postoperative recovery period.