The impact of socioeconomic deprivation on outcomes following open upper-limb fractures.

Socioeconomic deprivation is associated with increased trauma burden and poorer outcomes following open fractures. However, its impact on open upper-limb fractures remains unclear. This study examined whether socioeconomic deprivation influenced physiological status at presentation, Injury Severity Score and Gustilo-Anderson grade, time to surgical debridement, and early postoperative outcomes in patients treated within a regional major trauma network. We performed a retrospective cohort study using a prospectively maintained regional trauma registry at a Level I Major Trauma Centre. Consecutive patients presenting between 1 April 2014 and 1 April 2023 with open fractures of the humerus, radius, ulna, scapula, or clavicle were identified. Deprivation was determined using the postcode-linked 2019 Index of Multiple Deprivation. Patients without valid English IMD linkage were excluded. Outcomes were time to debridement, length of stay, 30- and 90-day readmission, reoperation within 1 year, and postoperative infection. Multivariable models adjusted for age, sex, American Society of Anesthesiologists grade, Injury Severity Score category, and Gustilo-Anderson grade. Of 297 identified patients, 291 were included. Patients from more deprived areas had poorer baseline physiological status, with ASA 3-4 status in 31.8% of the most deprived quintile compared with 10.0% of the least deprived quintile (p = 0.030). Gustilo-Anderson grade distribution differed across deprivation quintiles (p = 0.016), whereas Injury Severity Score category did not (p = 0.637). Time to debridement differed across IMD quintiles in unadjusted analysis (p = 0.017), but there was no linear association with continuous IMD decile after adjustment. IMD decile was not independently associated with length of stay, 90-day readmission, reoperation within 1 year, or postoperative infection. There was no statistically significant association with 30-day readmission (odds ratio 1.196, 95% CI 0.979-1.480; p = 0.080), although the estimate was imprecise. Patients from more deprived areas presented with poorer physiological status, and the distribution of Gustilo-Anderson grades differed across deprivation quintiles. However, after adjustment for measured clinical covariates, there was no clear evidence that deprivation was independently associated with delay to surgery or worse early postoperative outcomes. Standardised trauma care may help mitigate socioeconomic differences in early outcomes after upper-limb fractures.