Association of neighborhood social vulnerability with reoperation after operative treatment of proximal humerus fractures.

BACKGROUND: Neighborhood-level indices may capture different dimensions of social risk. We evaluated whether the Social Vulnerability Index (SVI) was associated with reoperation after operative treatment of acute proximal humerus fractures (PHFs), using the Area Deprivation Index (ADI) as a secondary comparator.

METHODS: This retrospective cohort included 438 distinct fracture episodes treated within a single United States practice group from January 2021 through December 2024. The outcome was ipsilateral shoulder reoperation for a postoperative complication. Primary logistic regression models adjusted for age, American Society of Anesthesiologists class, and diabetes mellitus; ADI analyses included 414 fractures.

RESULTS: Fifty-one fractures (11.6%) underwent reoperation. Reoperation increased from 6.4% to 16.1% across SVI quartiles (ordered trend P = 0.028; omnibus P = 0.163). Each 0.10 increase in SVI was associated with reoperation in the primary model (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.26; P = 0.033) and after adjustment for procedure category (OR, 1.13; 95% CI, 1.01-1.26; P = 0.027). ADI national and state ranks were not associated with reoperation.

CONCLUSIONS: Higher SVI was associated with reoperation, whereas ADI national and state ranks were not. These index-specific, hypothesis-generating findings require external validation.