Correlation of Social Determinants of Health Disparities With Outcomes After Bankart Repair: A Large Database Study

The correlation of social determinants of health disparities (SDHD) on outcomes after Bankart repair (BR) remains unclear.

The purpose of this study was to compare 90-day adverse events, health care utilization (physical therapy [PT] use, emergency department [ED] visits, and readmissions), and overall 90-day health care costs between patients with and without SDHD after primary BR. Secondary outcomes included 2-year complications (shoulder stiffness and subsequent ipsilateral shoulder surgery) between study groups. The authors hypothesized that SDHD patients would be at a higher risk of complications and greater health care utilization.

Cohort study; Level of evidence, 3.

Primary BR patients were identified from the PearlDiver M165 database from January 2010 through October 2022. The exclusion criteria included a history of neoplasm or infection within 90 days before the procedure, or inactivity in the database for 90 days postoperatively. Patients with SDHD within 1 year before surgery were identified with administrative coding. Patients with and without SDHD were matched (1:4) based on age, sex, surgery type (open vs arthroscopic), and the Elixhauser Comorbidity Index (a measure of comorbidity burden). Also, 90-day adverse events, PT utilization, ED visits, and readmissions were compared using multivariable logistic regression, controlling for all matching variables. Overall, 90-day reimbursements for arthroscopic BR were compared using a Wilcoxon rank sum test. Two-year postoperative shoulder stiffness and subsequent ipsilateral shoulder surgery were compared with multivariable analyses.

Of 142,594 BR patients, SDHD was identified in 4946 (3.5%). After the match, 4501 SDHD patients and 17,769 non-SDHD patients were selected. Multivariable logistic regression revealed that SDHD patients had a similar risk for all assessed individual and aggregated adverse events relative to non-SDHD patients. However, SDHD patients had higher PT utilization (odds ratio [OR], 1.22), ED visits (OR, 1.29), and total reimbursements (median [Q1-Q3]: $4446 [$2357-$7812] vs $3388 [$1765-$5919]) within 90 days postoperative (P < .0001 for all). For 2-year outcomes, SDHD was associated with increased shoulder stiffness (OR, 1.49; P < .001), but not subsequent ipsilateral shoulder surgery.

Our study demonstrated that SDHD patients undergoing BR experienced comparable 90-day medical complications, but greater health care utilization, higher costs, and 2-year stiffness risk. Further prospective research is warranted to elucidate effective targeted interventions that may mitigate these disparities.