The effect of social deprivation on hospital utilization following shoulder arthroplasty

Background

Disparities in social determinants of health have been linked to worse patient-reported outcomes and higher rates of hospital readmission following shoulder arthroplasty. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized in the context of shoulder arthroplasty.

Methods

A retrospective review was performed from of a single institution’s experience with primary shoulder arthroplasty between 2012 and 2020. Demographic variables (age, race, and legal sex) and healthcare utilization (hospital readmission, emergency department (ED) visits, follow-up visits, and telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on Area Deprivation Index tercile and compared.

Results

A total of 780 patients were included. The least, intermediate, and most deprived groups consisted of 195, 371, and 214 patients, respectively. The level of social deprivation was not a predictor of increased healthcare utilization through readmission, the ED, or the outpatient clinic. Identifying as Black or African American was an independent predictor of readmission and ED visitation. Female sex was an independent predictor of increased postoperative telephone calls.

Conclusion

Patients undergoing shoulder arthroplasty have similar use of hospital resources regardless of their level of social deprivation. We hope these results can be used to guide clinical decision-making, increase transparency, and manage patient outcomes following shoulder arthroplasty surgery.