Area deprivation index is associated with readmission and length of stay following primary shoulder arthroplasty

Abstract

Background

There is increased focus in the US health-care system on the role that social determinants of health have on disparities in health-care outcomes. Socioeconomic status has been identified as a crucial element affecting postoperative outcomes of elective orthopedic procedures. The Area Deprivation Index (ADI) is a metric used to quantify socioeconomic disadvantage between different neighborhoods or Census Block Groups. The ADI score for a given zip code is normalized to the entire country as a percentile or to a specific state as a decile to measure a neighborhood's relative socioeconomic disadvantage. Higher ADI scores indicate greater levels of social disadvantage. The purpose of this study was to assess the effect of ADI on postoperative length of stay (LOS), readmission, and emergency department (ED) visits following primary shoulder arthroplasty.

Methods

A retrospective review of a prospectively collected single-institution surgical database was conducted. Patients undergoing primary elective anatomic and reverse total shoulder arthroplasty were identified. Zip codes corresponding to patients' primary residence at the time of surgery were gathered and converted to ADI scores normalized to the state of California. A propensity score match was used to create demographically equivalent populations of low (<5) and high (≥5) ADI. We assessed the association between ADI and postoperative LOS, 30- and 90-day readmission, and 3-, 7-, and 90-day ED visits.

Results

A total of 1,012 patients were included in the study. An ADI of greater than or equal to 5 was significantly associated with lower readmission rate at 30 and 90 days (0.5% vs. 5.3%, P = .01). There was a positive correlation between high ADI and longer LOS, which did not reach statistical significance (30.42 hours vs. 27.55 hours, P = .089). There was no significant difference in ED visits at any time point between the low and high ADI groups.

Conclusion

An ADI of greater than or equal to 5, or higher socioeconomic disadvantage, was significantly associated with lower 30- and 90-day readmission rates after primary total shoulder arthroplasty. Our results also demonstrated a positive trend between high ADI and longer LOS postoperatively. Orthopedic providers should be mindful of their patients' level of social deprivation so that they may provide additional support and resources as necessary to improve their operative outcomes and mitigate their risk for complications.