Does patient education level affect 90-day outcomes and disposition following total joint arthroplasty?

Social determinants of health influence patient outcomes. In total joint arthroplasty (TJA), factors such as race, marital status, insurance type, and socioeconomic status affect outcomes and discharge disposition. One underexplored factor is patient education level. Although census data associate higher education with improved health outcomes, its impact following TJA has not been examined. This study evaluated differences in outcomes and discharge disposition between patients with higher versus lower education levels after TJA.

A retrospective review within an integrated healthcare system identified consecutive patients undergoing primary TJA from 2011 to 2021 using CPT codes 27130 (total hip arthroplasty [THA]) and 27447 (total knee arthroplasty [TKA]). Patients were grouped by education level: greater than high school (GHS) and less than or equal to high school (LHS), as documented in the medical record. Demographics, comorbidities, surgical variables, and 90-day postoperative complications were analyzed.

A total of 887 patients met inclusion criteria (451 GHS, 436 LHS) with mean follow-up of 6.7 ± 3.0 years. GHS patients were younger (63.8 ± 11.1 vs. 65.6 ± 12.0 years, p = 0.022) and less likely to undergo TKA (59% vs. 68%, p = 0.005). Groups were similar in race, body mass index, Charlson comorbidity index, smoking status, and insurance type. A greater proportion of GHS patients were discharged home (86% vs. 77%, p = 0.002). Among TKA patients, home discharge remained higher in GHS patients (85% vs. 75%, p = 0.019), with a similar trend in THA. There were no differences in length of stay, 90-day emergency department visits, readmissions, reoperations, or mortality.

Patients with greater than high school education were more likely to be discharged home following TJA, particularly TKA. Education level may help identify at-risk patients undergoing TJA and anticipate postoperative resource needs.