Socioeconomic Deprivation and Outcomes After Total Joint Arthroplasty: An Analysis of the American Joint Replacement...

There is an increasing interest in socioeconomic deprivation and its influence on outcomes in orthopaedics. This study aimed to examine the relationship between neighborhood-level social deprivation and its impact on 90-day readmission, length of stay, and all-cause revision after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).

A retrospective cohort study was conducted using data from the American Joint Replacement Registry merged with the Centers for Medicare and Medicaid Services claims for patients aged 18 years and over who had undergone primary unilateral TKAs and THAs. Comparisons were performed between patients grouped into Area Deprivation Index (ADI) quartiles by postal code (Quartiles 1 to 4, with Quartile 1 being the least disadvantaged). Subanalyses were performed using multinomial logistic regression and Cox proportional hazard models for outcomes with Quartile 1 serving as a reference. A total of 1,654,680 TKA and 1,051,311 THA procedures met the inclusion criteria.

Unadjusted analysis demonstrated significant differences in all outcomes based on ADI quartile (P < 0.001 for all outcomes except TKA all-cause revision, P = 0.003). In a subanalysis, Quartile 4 was significantly more likely to undergo readmission within 90 days for TKA (hazard ratio 1.631; 95% CI [confidence interval]: 1.528 to 1.741, P < 0.0001) and THA (hazard ratio 1.513; 95% CI: 1.406 to 1.629, P < 0.0001). For length of stay, Quartile 4 was significantly more likely to stay more than three days versus 1 day for TKA (odds ratio 1.103; 95% CI: 1.053 to 1.155, P < 0.0001) and THA (odds ratio 1.401; 95% CI: 1.312 to 1.496, P < 0.0001). There was a significant increase in all-cause revision for Quartile 4 for THA (hazard ratio 1.082, 95% CI: 1.008 to 1.162, P = 0.03), but there was no significant difference for TKA.

Socioeconomic deprivation as measured by the ADI is associated with increased 90-day readmission, length of stay, and all-cause revision after total joint arthroplasty. These findings support the need to address socioeconomic disparities in arthroplasty, both in risk stratification and in initiatives that support providers and systems treating disadvantaged populations at risk for increased resource utilization.