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The Association Between Preoperative Education Level and Long-Term Outcomes After Hip Arthroscopy
Jeffrey S Mun1, Srish S Chenna1, Rachel L Poutre1
1Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Background:
Social determinants of health (SDoH), including education level, are associated with postoperative outcomes and complication rates after orthopaedic surgery.
Purpose:
To evaluate the relationship between patient preoperative educational attainment (PEA) and (1) SDoH demographics, (2) long-term patient-reported outcomes (PROs), and (3) rates of revision surgery and conversion to total hip arthroplasty (THA) after primary hip arthroscopy.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A retrospective cohort study was conducted of patients who underwent hip arthroscopy at a single institution. Patients ≥18 years old with minimum 8-year follow-up PROs who underwent primary hip arthroscopy for treatment of symptomatic labral tears were included. Patient demographic, radiographic, and intraoperative variables were collected. Patients were divided into 2 PEA cohorts: (1) college education or less (CL) and (2) graduate or doctorate education (GD). PRO measures (PROMs) utilized in this study included modified Harris Hip Score (mHHS), International Hip Outcome Tool-33 (iHOT-33), and the Non-Arthritic Hip Score (NAHS). PROs, pain scores, satisfaction rates, revision rates, and THA conversion rates were compared.
Results:
Overall, 164 patients met inclusion criteria. Both the CL and the GD PEA groups consisted of 82 patients, with mean follow-up of 11.2 ± 2.6 years and 11.1 ± 2.4 years, respectively (P = .34). There were no differences in baseline demographics and radiographic findings between cohorts (P > .05). CL PEA patients resided in more socioeconomically disadvantaged neighborhoods (mean Area Deprivation Index, 23.1 vs 13.9; P < .001) and lived in neighborhoods with worse community-level health literacy estimates (254.4 vs 257.6; P = .03). At minimum 8-year follow-up, GD PEA patients demonstrated higher mean modified Harris Hip Score (mHHS) (89.5 vs 82.8; P = .003) and International Hip Outcome Tool-33 (iHOT-33) (77.5 vs 69.4; P = .04) scores. By multivariate logistic regression, GD PEA patients had greater odds of achieving 10-year Patient Acceptable Symptom State (PASS) for mHHS and the Non-Arthritic Hip Score) compared with CL PEA patients (odds ratio [OR], 3.0; 95% CI, 1.38-6.51; P = .006; OR, 2.4; 95% CI, 1.14-5.22; P = .02). Revision hip arthroscopy and conversion to THA rates were similar between cohorts.
Conclusion:
Our study demonstrates that GD PEA patients have significantly higher PROs and greater odds of reaching the PASS at minimum 8-year follow-up compared with CL PEA patients. Furthermore, lower PEA is associated with greater socioeconomic disadvantage. The data suggest that orthopaedic surgeons may use education-level data as an important clinical decision-making tool to assess for long-term functional outcomes and secondary surgery rates after hip arthroscopy.
