D77. Barriers to Care in Obstetric Brachial Plexus Palsy: Assessing the Impact of Area of Deprivation Index and Urban-Rural Locale on Patient Recovery

PURPOSE: Obstetric brachial plexus palsy (OBPP) is a serious complication of birth. When evaluating infants for OBPP, potential barriers to care must be considered to promote successful follow-up. This study aims to assess the role of socioeconomic context on outcomes for OBPP patients. METHODS: A retrospective review was performed for OBPP infants who presented to Children's Hospital of Pittsburgh from 2008 to 2020. Area of Deprivation Index (ADI) and urban-rural locale were collected for each patient. Outcomes of interest included complete recovery, surgical intervention, and follow-up duration. Multivariate regression was performed to identify associations with OBPP outcomes. RESULTS: Of 195 patients that met inclusion criteria, 73 (37.4%) patients underwent surgery (x̄ = 1.3 ± 2.2 years) with a median ADI of 76. Thirty-two percent (31.8%) of patients were of rural locale and 23.3% of patients were of non-white background. Rural location was significantly associated with decreased surgical intervention (OR 0.5, CI 0.256-0.982, p=.04). Higher ADI significantly correlated with lower AMS scores at 9 months and at most recent follow-up (R2 = -0.31, p=.004; R2=-0.136, p=.04). Non-white background was significantly associated with lower birth weights (p=.04), lower AMS scores at 3 months (p=.004), 6 months (p =.009), 9 months (p<.001), post-operatively (p=.01), and at most recent follow-up (p <.001), compared to white patients. CONCLUSION: This study demonstrates that socioeconomic context may impact OBPP management and outcomes. Our findings highlight the importance of regular follow-up and the reevaluation of resources available for those experiencing obstacles to care.