Neighborhood-Level Socioeconomic Deprivation, Rurality, and Long-Term Outcomes of Patients Undergoing Total Joint Arthroplasty: Analysis from a Large, Tertiary Care Hospital

Kamath, Celia C.; O’Byrne, Thomas J.; Lewallen, David G.; Berry, Daniel J.; Kremers, Hilal Maradit

doi:10.1016/j.mayocpiqo.2022.06.001

Cited by 17 publications

(10 citation statements)

References 32 publications

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“…It allows for the measurement and quantification of SES of a specific geographic area, providing a more nuanced and accurate picture of an individual's environment and their access to resources and opportunities. 16,19,20,29 For example, our study found that significantly more patients in the least socioeconomically deprived cohort identified as White compared with the most socioeconomically deprived group. However, for the 3 PROMIS domains, ''White'' race was not significant in predicting attainment of MCID.…”

Section: Discussionmentioning

confidence: 56%

“…Overall, they reported that patients within the most socioeconomically deprived ADI quartile had significantly worse PROMIS Upper Extremity and PI compared with the least socioeconomically disadvantaged group. Kamath et al 16 investigated 46,828 Total Joint Arthroplasty (TJA) surgeries performed on patients at a tertiary care hospital, investigating the role of the ADI on the risk of postoperative complication, need of revision, and mortality. Overall, the group reported that patients in the most deprived ADI quartile were more likely to have revision surgery and had a higher incidence of mortality compared with the least-deprived ADI quartile.…”

Section: Discussionmentioning

confidence: 99%

“…The score is normalized relative to a national mean score of 50. 16 Patient addresses were coded into census blocks via R Studio 4.13 (PBC, Boston, MA). After a census block was assigned to each patient, it was mapped over the census block ADI reference provided by Center for Health Disparities at the University of Wisconsin.…”

Section: Methodsmentioning

confidence: 99%

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Use of Area Deprivation Index to Predict Minimal Clinically Important Difference for Patient Reported Outcomes Measurement Information System After Arthroscopic Rotator Cuff Repair

et al. 2023

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Background: Socioeconomic disparities correlate with worse outcomes after arthroscopic rotator cuff repair. However, use of a surrogate to describe socioeconomic disadvantage has been a challenge. The Area Deprivation Index (ADI) is a tool that encompasses 17 socioeconomic variables into a single metric based on census location. Hypothesis: Higher ADI would result in a worse minimal clinically important difference (MCID) for the Patient Reported Outcomes Measurement Information System (PROMIS) and have less improvement in range of motion (ROM) following arthroscopic rotator cuff repair (ARCR). Study Design: Cohort study; Level of evidence, 3. Method: A retrospective review was performed for patients who underwent arthroscopic rotator cuff repair. Patients in the most socioeconomically disadvantaged quartile (ADIHigh) were compared with the least disadvantaged quartile (ADILow) in the ability to reach MCID. Demographic and surgical features were assessed for attainment of MCID. Results: In total 1382 patients were identified who underwent ARCR, of which a total of 306 patients met final inclusion criteria. A higher percentage of patients within the ADIHigh cohort identified as “Black” or “other” race and had government-issued insurance compared with the ADILow cohort ( P < .05). The ADIHigh cohort had significantly worse postoperative forward flexion compared with the ADILow cohort (145.0°± 32.5° vs 156.3°± 23.4°; P = .001) despite starting with comparable preoperative ROM ( P = .17). Logistic regression showed that ADI was the only variable significant for predicting achievement of MCID for all 3 PROMIS domains, with the ADIHigh cohort having significantly worse odds of achieving MCID Physical Function (odds ratio [OR], 0.31; P = .001), Pain Interference (OR, 0.21; P = .001), and Depression (OR, 0.28; P = .001). Meanwhile, age, sex, body mass index, and smoking history were nonsignificant. Moreover, “other” for race and Medicare insurance were significant for achievement of MCID Depression but not Physical Function or Pain Interference. Finally, ADI was the main feature for predictive logistic regression modeling. Conclusion: ADI served as the only significant predictor for achieving MCID for all 3 PROMIS domains after arthroscopic rotator cuff repair. Patients who face high levels of socioeconomic disadvantage have lower rates of achieving MCID. In addition, patients with greater neighborhood disadvantage demonstrated significantly worse improvement in active forward flexion. Further investigation is required to understand the role of ADI on physical therapy compliance and to identify the barriers that prevent equitable postoperative care.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

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Use of Area Deprivation Index to Predict Minimal Clinically Important Difference for Patient Reported Outcomes Measurement Information System After Arthroscopic Rotator Cuff Repair

et al. 2023

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“…A previous study involving total hip and knee arthroplasty found that, irrespective of neighbourhood-level deprivation or geographical disadvantage, patients who had access to arthroplasty surgery at a high-volume tertiary centre with subspecialty care have relatively good long-term outcomes. 27 Access to high-volume shoulder arthroplasty surgeons who are equipped to treat difficult revision cases is lacking in many major metropolitan areas in the USA. 28 Previous authors have also shown that patients who are treated in centres with more specialist surgeons and high volumes of TSAs have reduced lengths of stay in hospital and complication rates.…”

Section: Discussionmentioning

confidence: 99%

Higher complication rates following primary total shoulder arthroplasty in patients presenting from areas of higher social deprivation

Mandalia,

Brodeur,

et al. 2024

Bone Joint J

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AimsThe aim of this study was to characterize the influence of social deprivation on the rate of complications, readmissions, and revisions following primary total shoulder arthroplasty (TSA), using the Social Deprivation Index (SDI). The SDI is a composite measurement, in percentages, of seven demographic characteristics: living in poverty, with < 12 years of education, single-parent households, living in rented or overcrowded housing, households without a car, and unemployed adults aged < 65 years.MethodsPatients aged ≥ 40 years, who underwent primary TSA between 2011 and 2017, were identified using International Classification of Diseases (ICD)-9 Clinical Modification and ICD-10 procedure codes for TSA in the New York Statewide Planning and Research Cooperative System database. Readmission, reoperation, and other complications were analyzed using multivariable Cox proportional hazards regression controlling for SDI, age, ethnicity, insurance status, and Charlson Comorbidity Index.ResultsA total of 17,698 patients with a mean age of 69 years (SD 9.6), of whom 57.7% were female, underwent TSA during this time and 4,020 (22.7%) had at least one complication. A total of 8,113 patients (45.8%) had at least one comorbidity, and the median SDI in those who developed complications 12 months postoperatively was significantly greater than in those without a complication (33 vs 38; p < 0.001). Patients from areas with higher deprivation had increased one-, three-, and 12-month rates of readmission, dislocation, humeral fracture, urinary tract infection, deep vein thrombosis, and wound complications, as well as a higher three-month rate of pulmonary embolism (all p < 0.05).ConclusionBeyond medical complications, we found that patients with increased social deprivation had higher rates of humeral fracture and dislocation following primary TSA. The large sample size of this study, and the outcomes that were measured, add to the literature greatly in comparison with other large database studies involving TSA. These findings allow orthopaedic surgeons practising in under-served or low-volume areas to identify patients who may be at greater risk of developing complications.Cite this article: Bone Joint J 2024;106-B(2):174–181.

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“…SDoH have been shown to effect outcomes in several orthopedic subspecialties, including joint arthroplasty, upper extremity surgery, spine, trauma, and sports medicine. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Therefore, it is crucial for orthopedic surgeons to understand the connection that SDoH may have in predisposing patients to inferior outcomes following surgeries.…”

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confidence: 99%

The Effect of Social Deprivation on Hospital Utilization Following Distal Radius Fracture Treatment

Van Boxtel,

Jauregui,

Valiquette

et al. 2024

Journal of Hand Surgery Global Online

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Neighborhood-Level Socioeconomic Deprivation, Rurality, and Long-Term Outcomes of Patients Undergoing Total Joint Arthroplasty: Analysis from a Large, Tertiary Care Hospital

Cited by 17 publications

References 32 publications

Use of Area Deprivation Index to Predict Minimal Clinically Important Difference for Patient Reported Outcomes Measurement Information System After Arthroscopic Rotator Cuff Repair

Use of Area Deprivation Index to Predict Minimal Clinically Important Difference for Patient Reported Outcomes Measurement Information System After Arthroscopic Rotator Cuff Repair

Higher complication rates following primary total shoulder arthroplasty in patients presenting from areas of higher social deprivation

The Effect of Social Deprivation on Hospital Utilization Following Distal Radius Fracture Treatment

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