Lower socioeconomic status is not associated with worse 2-year outcomes following reverse total shoulder arthroplasty

Abstract

Background

The aim of this study was to evaluate the association between Area Deprivation Index (ADI) and patient outcomes following reverse total shoulder arthroplasty (rTSA).

Methods

A retrospective analysis of patients who underwent an rTSA at a single institution between 2011 and 2021 with minimum 2-year follow-up. Each patient's home address was mapped to the ADI to determine the level of socioeconomic disadvantage. Patients were categorized into 5 groups based on socioeconomic status (SES): ADI group 1; the least deprived group and ADI group 5; the most deprived group. Bivariate analysis was performed to determine the association between the level of SES and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score. Multivariable regression analysis was utilized to assess the role of independent variables in achieving minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for ASES.

Results

A total of 551 patients, mean age: 71.1 ± 9.1 year/old and overall mean follow-up time of 42.5 ± 29.9 months. The mean ADI value of all cohorts was 49.3 ± 29.4. The mean ADI for groups 1 through 5 were 9.0 ± 4.9, 30.1 ± 7.6, 47.6 ± 4.4, 70.9 ± 6.7, and 89.9 ± 5.2. There were no differences in age, sex, body mass index, or preoperative medical comorbidities. The average preoperative ASES score across ADI subgroups was 30.6 ± 18.0. Preoperative ASES scores were lowest in both ADI group 1:26.5 ± 15.3 and ADI group 5:25.9 ± 16.7. There was no difference in preoperative range of motion (ROM) across all ADI subgroups. The average postoperative ASES score was 74.2 ± 23.7. There was a significant inverse relationship between ADI and postoperative ASES (P = .047). ADI group 1 had the highest postoperative ASES score of 78.6 ± 21.6 compared to 70.0 ± 24.1 in group 5. There was no difference in change preoperative to postoperative ASES scores across ADI subgroups with an average delta ASES score of 42.8 ± 26.2. Like preoperative ROM, there was no difference across ADI subgroups in terms of postoperative ROM. The average percentage of the cohort of patients across ADI subgroups that achieved MCID, SCB, and PASS for ASES was 87.6%, 68.9%, and 57.5%, respectively. There was no difference in terms of achieving MCID, SCB, or PASS for ASES across ADI subgroups.

Conclusion

The current study supports an inverse relationship between ADI and postoperative outcomes in patients undergoing rTSA. Additionally, our study found that a patient's ability to achieve MCID, SCB, or PASS for ASES at a minimum of 2 years after rTSA was not dependent on SES. Lastly, our study demonstrated that the risk of suffering an adverse event or undergoing a revision surgery were not associated with SES.