区域剥夺指数和社会脆弱性指数对ACL重建后PROMIS结果及MCID达成的影响
简介
本研究回顾性分析576例行关节镜下ACL重建患者的资料，基于区域剥夺指数（ADI）和社会脆弱指数（SVI）四分位数分组，比较各组术前及术后≥6个月PROMIS评分及MCID达标率。结果显示：尽管ADI最高四分位组术后疼痛干扰和抑郁评分更差，且疼痛干扰项的MCID达标率显著降低（OR=0.55），但各组术后各功能领域均显著改善，总体MCID达标率较高且与ADI…
英文摘要
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction typically yields excellent outcomes, but recent attention has turned to how social determinants of health affect recovery. This study evaluates the association of the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) with scores on the Patient-Reported Outcomes Measurement Information System (PROMIS) and the likelihood of patients undergoing ACL reconstruction surgery achieving the minimal clinically important difference (MCID) postoperatively. HYPOTHESIS: Greater social deprivation and vulnerability correlate with worse outcomes and lower odds of achieving the MCID after ACL reconstruction surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors retrospectively reviewed patients aged ≥13 years who underwent arthroscopic ACL reconstruction between 2015 and 2023 and completed preoperative and ≥6-month postoperative PROMIS surveys. ADI and SVI scores were based on geocoded addresses and zip codes, respectively, and divided into quartiles based on percentile rank (0-25th, 25th-50th, 50th-75th, and 75th-100th). The least deprived quartile was quartile 1 and the most was quartile 4. Statistical analyses included analysis of variance, chi-square test, and logistic regression to assess associations with PROMIS scores and MCID achievement. RESULTS: A total of 576 patients met inclusion criteria (mean ± SD age, 27.9 ± 11.7 years). ADI and SVI quartiles were evenly distributed. Significant differences were found in race, body mass index, insurance status, and smoking history across quartiles. Patients in the highest ADI/SVI quartiles had higher body mass index, more Black representation, and greater use of public insurance. Preoperative PROMIS scores were mostly similar, except for higher pain interference in the most deprived quartile. Postoperative improvements were significant across all domains after surgery (P < .05). ADI quartile 4 had worse pain interference and depression scores as compared with the less deprived quartiles. MCID achievement was generally high, but logistic regression showed lower odds of achieving the MCID for pain interference in ADI quartile 4 after ACL reconstruction surgery (odds ratio, 0.55; P = .018). CONCLUSION: Despite socioeconomic disparities, ACL reconstruction surgery led to meaningful improvements in function and mental health outcomes. Although patients in higher ADI quartiles demonstrated worse postoperative pain interference and depression scores, overall MCID achievement was not associated with ADI or SVI, suggesting that ACL reconstruction benefits patients across socioeconomic backgrounds. These findings suggest that social determinants of health may influence the magnitude of postoperative outcomes, but patients of varying socioeconomic backgrounds benefit from ACL reconstruction surgery.