Primary Total Knee and Total Hip Arthroplasty in the Rural Patient

Area of Science:

• Orthopedic Surgery
• Rural Health Disparities
• Health Services Research

Background:

• Rural populations exhibit poorer health outcomes, with a higher prevalence of conditions like osteoarthritis.
• Access to specialized surgical care can be a challenge for patients residing in rural areas.

Purpose of the Study:

• To compare rural patients undergoing primary total joint arthroplasty (TJA) in rural versus urban hospitals.
• To analyze demographic differences, comorbidities, and complication rates between the two settings.
• To identify the preferred care location for rural patients seeking TJA.

Main Methods:

• Analysis of data from the Healthcare Cost and Utilization Project National Inpatient Sample (2016-2018).
• Comparison of demographics, comorbidities, inpatient complications, length of stay, mortality, and discharge disposition.
• Stratification of outcomes based on hospital location (rural vs. urban) for rural patients.

Main Results:

• Rural TJA patients at rural hospitals were more likely to be female, from the South, have Medicaid, and present with dementia, diabetes, lung disease, and pulmonary complications.
• These patients also experienced longer hospital stays but fewer postoperative infections and cardiovascular complications.
• Rural patients with more complex comorbidities and resources tended to choose urban facilities for TJA.

Conclusions:

• Rural patients with manageable comorbidities may opt for TJA at rural hospitals.
• Increasingly, rural patients with complex health profiles and resources are selecting urban hospitals for TJA, indicating a preference for specialized care.
• This trend highlights potential disparities in access to advanced orthopedic care in rural settings.