Rurality Is Not Associated With 90-Day Readmissions or Complications After Primary Total Hip or Knee Arthroplasty...

Social determinants of health (SDOH) and rurality can impact orthopaedic surgery outcomes; however, the relative contribution of each factor remains unclear. The purpose of this study was to examine the association between patients' rurality and geographical SDOH, with 90-day complications and readmissions in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA) in the state of New York.

This was a retrospective cohort study of patients undergoing primary THA (195,051) and TKA (288,524) using a large administrative database between January 1, 2016, and December 31, 2023. The social vulnerability index (SVI) was used to identify a composite ranking of SDOH. The primary outcomes included 90-day complications and readmissions. Regression analyses were used to identify the association of rurality, SVI, and the interaction between these measures with the primary outcomes while adjusting for relevant confounding variables.

When adjusting for underlying confounding variables, rurality was not independently associated with 90-day complication rates after THA (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 0.84 to 1.22; P = 0.247) or TKA (OR: 1.48, 95% CI: 0.93 to 2.36; P = 0.101), or 90-day readmission rates after THA (OR: 0.97, 95% CI 0.73 to 1.28; P = 0.826) or TKA (OR: 0.95, 95% CI 0.74 to 1.30; P = 0.692). However, composite SVI for the most at-risk communities, particularly in urban areas, was independently associated with increased 90-day readmission rate (OR: 1.14, 95% CI: 1.04 to 1.25; P = 0.005) after THA and increased 90-day complication rates (OR: 1.25, 95% CI: 1.03 to 1.53; P = 0.026) after TKA.

Rurality was not independently associated with 90-day complications or readmissions in primary THA or TKA in New York State. The SDOH as described by the composite SVI ranking was associated with 90-day readmission rates in primary THA and 90-day complications in primary TKA in the most vulnerable patient populations.