How Social Determinants of Health Affect Outcomes Following Rotator Cuff Repair

There has been an increased interest within orthopaedics investigating disparities in outcomes among populations of low socioeconomic status (SES). This study aims to investigate how SES, investigated by proxy through geocoding, affects postoperative outcomes following repair of rotator cuff tears.

A total of 322 patients undergoing full-thickness rotator cuff tear repair (RCR) at a single institution from 2014 to 2021 were retrospectively reviewed and stratified by median household income and Social Deprivation Index (SDI) per zip code. Primary outcomes included patient-reported outcome measures (PROMs) at 12 months postoperatively. Multiple linear regression examined which variables correlated with American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores.

The extremely/very low-income and high SDI patients had significantly decreased ASES, SANE, and satisfaction scores at 12 months postoperatively based on one-way analysis of variance (ANOVA) analysis. Multiple linear regression revealed that low- and medium-income groups had notable positive correlations with ASES and SANE scores. Highest SDI quartile, body mass index, female sex, and current smoking status had notable negative correlations with PROMs.

Based on ANOVA, patients from areas of lowest income and highest SDI had lower PROMs following RCR, although multiple regression demonstrates that PROMs are multifactorial. The results should be interpreted in the context of current literature and used to raise awareness among orthopaedic surgeons of risk factors affecting PROMs following RCR. As health care trends toward patient satisfaction-driven financial models, we stress the importance of risk-adjusted compensation and performance models for orthopaedic surgeons performing RCRs and preoperative expectation counseling.