Podium Presentation Title: Disparities in the Surgical Management of Shoulder Instability After Emergency Room Presentation

To evaluate the socioeconomic and demographic factors affecting whether a patient undergoes stabilization surgery after presenting to the emergency room for shoulder instability. Patients presenting to the emergency department were identified in the New York Statewide Planning and Research Cooperative System database from 2015-2018 by International Classification of Disease 10 Clinical Modification diagnosis codes for anterior shoulder dislocation or subluxation. All shoulder stabilization procedures in the outpatient setting were identified using Current Procedural Terminology codes. Using a unique identifier for each patient, the diagnosis data was linked to procedure data. A multivariable logistic regression was performed to assess the impact of patient factors on the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation (SDI), Charlson Comorbidity Index (CCI), repeat dislocation, and primary insurance type. 16,721 patients were included in the analysis and 1,028 (6.1%) went on to have stabilization surgery. Younger ages, those with recurrent dislocations (OR=2.606, p<.0001), or workers compensation relative to private insurance (OR=1.318, p=0.0492) had increased odds of receiving surgery. Hispanic (OR=0.711, p=0.003) and African American (OR=0.63, p<.0001) patients had decreased odds of surgery relative to White patients. Patients with Medicare (OR=0.389, p<.0001), Medicaid (OR=0.582, p<.0001), or self-pay (OR=0.352, p<.0001) were all less likely to undergo surgery relative to privately insured patients. Higher social deprivation (OR=0.993, p<.0001) was also associated with decreased odds of surgery. Shoulder instability and subsequent stabilization surgery is associated with disparities among race, primary insurance, and social deprivation. Considering the relationship between differential care and health disparities, it is critical to define the disparities involved and increase physician awareness to promote appropriate management of shoulder instability. This study can help provide the basis for policy interventions to improve access to equitable orthopaedic care.