Homelessness is associated with increased 90 day and 1 year complications after upper extremity fractures fixation.

BACKGROUND

This study examines 90-day outcomes and one-year outcomes following surgical fixation of upper extremity fractures in homeless patients.

METHODS

A retrospective analysis was conducted using a nationwide database to identify patients who underwent open reduction and internal fixation of upper extremity fractures including (shoulder and upper arm, elbow and forearm, wrist and hand) and had documented homelessness status. Patients were 1:1 propensity score-matched to controls based on demographic factors, comorbidities (including chronic kidney disease, hypertension, heart failure, diabetes mellitus, liver diseases, substance abuse and opioid dependence) and BMI yielding 2,584 patients per group. Primary outcomes included fracture related outcomes while secondary outcomes were healthcare utilization, medical and substance related outcomes. Relative risks (RR), 95% confidence intervals (CI), and p-values were calculated.

RESULTS

At 90 days, homeless patients had significantly higher risks of emergency department visits (RR: 5.18, p < 0.001), sepsis (p = 0.002), opioid dependence (RR: 2.88, p = 0.002), substance abuse (RR: 5.87, p < 0.001), renal failure (RR: 3.34, p < 0.001), pneumonia (RR: 2.90, p < 0.001), transfusion (RR: 2.61, p = 0.003), readmission (RR: 3.22, p < 0.001), wound complications (RR: 1.97, p < 0.001), and postoperative infection (RR: 2.70, p < 0.001). At 1 year, homeless patients had elevated risks of opioid dependence (RR: 4.69, p < 0.001), substance abuse (RR: 5.72, p < 0.001), opioid use (RR: 1.58, p = 0.011), revision surgery (RR: 1.78, p = 0.017), and malunion (RR: 1.92, p = 0.013).

CONCLUSION

Homeless patients undergoing upper extremity fractures ORIF face significantly higher risks of 90 day and 1 year adverse outcomes compared to housed patients. These findings highlight the critical need for tailored interventions to improve care continuity, minimize risks and improve outcomes in homeless individuals.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort.