O1078: Socioeconomic Deprivation and Its Associations with Aftercare Following In-situ Pinning of Slipped Capital Femoral Epiphysis

Background: Slipped capital femoral epiphysis (SCFE) is common cause of hip pain in the adolescent patient and is most often treated with in situ screw fixation. While surgeons may disagree about when to prophylactically pin the contralateral side in unilateral SCFE, all would concur that continual orthopaedic follow-up until skeletal maturity is critical for both the risk of femoroacetabular impingement as well as subsequent contralateral slip (in cases of unilateral fixation). Recent studies have shown that socioeconomic deprivation is associated with decreased fracture care compliance, but no studies have explored this relationship with SCFEs. The purpose of this study was to determine the relationship between socioeconomic deprivation and SCFE follow-up care compliance.

Methods: This study included patients under 18 years of age who were treated with in-situ pinning of SCFE between 2011 and 2019 at a single tertiary-care urban children’s hospital. Demographic information (sex, race, insurance status, age) and clinical information (injury and treatment data) were obtained from query of electronic medical records. The Area Deprivation Index (ADI), a composite measure of deprivation at the Census-track level, was used to quantify the socioeconomic deprivation for each patient and was reported as national percentile values (median national value, 50). Outcome variables included patient age and status of physeal closure at most recent appointment and overall length of follow-up (months). Statistical relationships were evaluated using nonparametric bivariate analysis and correlation.

Results: We identified 247 evaluable patients; 141 patients (56.6%) were male, and the median age was 12.4 years. Most slips were stable (235/247, 94.4%) and treated with isolated unilateral pinning (138, 55.9%). The median length of follow-up was 11.9 months (interquartile range (IQR), 4.95-23.1) with a median patient age at the final follow-up visit of 13.6 years (IQR, 12.4-15.1); only 36.9% of patients were followed until physeal closure. Mean ADI national percentile was 51.5 (SD, 30.4), with approximately 25% of patients falling into each quartile. Patients in the most deprived quartile were lost to follow-up significantly earlier (median, 6.5 months) than those in the least deprived quartile (median, 12.5 months; p < .001). Throughout the entire cohort, there was a significant, inverse relationship between deprivation and follow-up length (rs(238) = -.3, p < .001).

Conclusion: In this sample, ADI spread was representative of national trends and the incidence of SCFE was distributed evenly across quartiles of deprivation. However, follow-up length was not evenly distributed: increased socioeconomic deprivation was associated with an earlier loss to follow-up. As close monitoring is paramount in this condition, caregivers should be alert to the potential for patients being lost to follow-up, especially in the most economically deprived population. It is important to consider follow-up care after SCFE when making informed recommendations regarding prophylactic pinning.