The Influence of Social Determinants of Health Across the Craniofacial Fracture Care Continuum: A Systematic Review

Kevin Vargas BS1, Sai Unnam BSBE1, Neeraj Suresh BS2, Anthony Shadid BA1, Philong Nguyen BS3, Joshua Wang BS3, Renata Maricevich MD1, Lucas A. Dvoracek MD1

1School of Medicine, Baylor College of Medicine, Houston, TX, 2Department of Anesthesiology, McGovern Medical School, 3School of Medicine, The University of Texas Medical Branch, Galveston, TX

INTRODUCTION

• Social Determinants of Health (SDoH) are critical non-clinical drivers that fundamentally shape health disparities and patient outcomes across surgical specialties

• While their influence is acknowledged, a comprehensive evaluation of how these factors impact the entire facial fracture care continuum, from initial injury risk to postoperative recovery, is necessary to identify systemic inequities

• Understanding the cumulative effect of socioeconomic barriers is essential for developing targeted, evidence-based interventions that promote health equity in facial trauma care

• This study addresses the need for a systematic synthesis of existing literature to delineate how SDoH creates a cycle of disadvantage for vulnerable patient populations

GOAL/HYPOTHESIS

• This study aimed to systematically evaluate the impact of Social Determinants of Health (SDOH) across the facial fracture care continuum, from injury risk to postoperative recovery

METHODS (CONT.)

Table 1: Database Synthesis

First Author (Year)	Data Source	Sample Size
Derakhshan (2024)	State Inpatient Databases (NY, MD, FL)	1,277
Hyman (2016)	National Trauma Data Bank (NTDB)	518,106
Mancera (2022)	Single Center (Urban Level I)	410
Musavi (2021)	National Inpatient Sample (NIS)	78,730
Perla (2022)	National Inpatient Sample (NIS)	268,809
Wang (2024)	Nationwide Emergency Dept Sample (NEDS)	27,239
Yu (2023)	SEDD / SASD (CA, NY, FL)	762
Total Pooled Analysis Sample: 895,333 Patients

RESULTS

Figure 2: The 3-Stage Care Continuum Map

1. SUSCEPTIBILITY

2. ACUTE CARE

Timing: Minority race predicts >48hr delay to OR3

Management: Medicaid status predicts likelihood of ORIF (OR 3.31)4

Inpatient: Medicaid assoc. with 50% longer LOS4

 

3. RECOVERY

Outcome: Uninsured status trends toward post-op ER visits (OR 2.41)5

Complications: Medicaid trends toward post-operative dehiscence (OR 1.93)4

Discharge: Medicare/uninsured status decreases home discharge4

 

Inequity burden compounds at each successive transition of care.

RESULTS (CONT.)

Figure 3: Independent Multivariate Predictors of Outcome

 

CONCLUSION/DISCUSSION

• SDOH create cumulative disadvantages, amplifying facial fracture susceptibility and recovery barriers

• Significant disparities exist across race, demographics, income, and health status at every stage of care

• Variations in study design and SDOH measurement underscore the need for standardized, prospective investigations to delineate modifiable pathways and guide evidence-based interventions promoting health equity

 

REFERENCES

1. Derakhshan A, Archibald H, Dresner HS, et al. Premorbid Incidence of Mental Health and Substance Abuse Disorders in Facial Trauma Patients. Craniomaxillofac Trauma Reconstr. 2024;17(4):NP257-NP262. doi:10.1177/19433875241280780

2. Mancera N, Do DP, Griepentrog GJ, Esmaili N. Assault-related Orbital Trauma at an Urban Level I Trauma Center: Racial Segregation and Other Neighborhood-level Social Determinants. Ophthalmic Plast Reconstr Surg. 2023;39(2):182-186. doi:10.1097/IOP.0000000000002286

3. Musavi LS, Chin P, Pfaff M, Fadavi D, Aliu O, Yang R. Treatment of Facial Fractures at Safety-Net Hospitals: A National Analysis of Inpatient Burden and Cost. J Craniofac Surg. 2021;32(4):1413-1416. doi:10.1097/SCS.0000000000007573

4. Rivera Perla KM, Lopez CD, Zeyl VG, et al. Insurance Status Influences Mandible Fracture Management and Outcomes: A National Inpatient Sample Analysis of 268 809 Admissions. FACE. 2022;3(4):494-504. doi:10.1177/27325016221129620

5. Yu AJ, Collet C, Su P, Ference E, Moayer R. Ambulatory Orbital Fracture Repair: An Analysis of ER Visits After Surgery From a Multistate Study. Otolaryngol Head Neck Surg. 2023;169(6):1445-1454. doi:10.1002/ohn.428

 

ACKNOWLEDGEMENTS

The authors gratefully acknowledge the Baylor College of Medicine Division of Plastic Surgery for their support and for providing the academic environment necessary to pursue this research.