Are social determinants of health associated with an increased length of hospitalization after revision total hip and knee arthroplasty? A comparison study of social deprivation indices
- 02.07.2024
- Orthopaedic Surgery
Erschienen in:
- Verfasst von
- Michelle Riyo Shimizu
- Anirudh Buddhiraju
- Oh-Jak Kwon
- Tony Lin Wei Chen
- Jona Kerluku
- Young-Min Kwon
- Erschienen in
- Archives of Orthopaedic and Trauma Surgery | Ausgabe 7/2024
Abstract
Introduction
Length of stay (LOS) has been extensively assessed as a marker for healthcare utilization, functional outcomes, and cost of care for patients undergoing arthroplasty. The notable patient-to-patient variation in LOS following revision hip and knee total joint arthroplasty (TJA) suggests a potential opportunity to reduce preventable discharge delays. Previous studies investigated the impact of social determinants of health (SDoH) on orthopaedic conditions and outcomes using deprivation indices with inconsistent findings. The aim of the study is to compare the association of three publicly available national indices of social deprivation with prolonged LOS in revision TJA patients.
Materials and methods
1,047 consecutive patients who underwent a revision TJA were included in this retrospective study. Patient demographics, comorbidities, and behavioral characteristics were extracted. Area deprivation index (ADI), social deprivation index (SDI), and social vulnerability index (SVI) were recorded for each patient, following which univariate and multivariate logistic regression analyses were performed to determine the relationship between deprivation measures and prolonged LOS (greater than five days postoperatively).
Results
193 patients had a prolonged LOS following surgery. Categorical ADI was significantly associated with prolonged LOS following surgery (OR = 2.14; 95% CI = 1.30–3.54; p = 0.003). No association with LOS was found using SDI and SVI. When accounting for other covariates, only ASA scores (ORrange=3.43–3.45; p < 0.001) and age (ORrange=1.00–1.03; prange=0.025–0.049) were independently associated with prolonged LOS.
Conclusion
The varying relationship observed between the length of stay and socioeconomic markers in this study indicates that the selection of a deprivation index could significantly impact the outcomes when investigating the association between socioeconomic deprivation and clinical outcomes. These results suggest that ADI is a potential metric of social determinants of health that is applicable both clinically and in future policies related to hospital stays including bundled payment plan following revision TJA.
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- Titel
- Are social determinants of health associated with an increased length of hospitalization after revision total hip and knee arthroplasty? A comparison study of social deprivation indices
- Verfasst von
-
Michelle Riyo Shimizu
Anirudh Buddhiraju
Oh-Jak Kwon
Tony Lin Wei Chen
Jona Kerluku
Young-Min Kwon
- Publikationsdatum
- 02.07.2024
- Verlag
- Springer Berlin Heidelberg
- Erschienen in
-
Archives of Orthopaedic and Trauma Surgery / Ausgabe 7/2024
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916 - DOI
- https://doi.org/10.1007/s00402-024-05414-2
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