Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, USA.
Bone Joint J. 2021 Jun;103-B(6 Supple A):113-118. doi: 10.1302/0301-620X.103B6.BJJ-2020-2430.R1.
Social determinants of health (SDOHs) may contribute to the total cost of care (TCOC) for patients undergoing total knee arthroplasty (TKA). The aim of this study was to investigate the association between demographic data, health status, and SDOHs on 30-day length of stay (LOS) and TCOC after this procedure.
Patients who underwent TKA between 1 January 2018 and 31 December 2019 were identified. A total of 234 patients with complete SDOH data were included. Data were drawn from the Chesapeake Regional Information System, the Centers for Disease Control social vulnerability index (SVI), the US Department of Agriculture, and institutional electronic medical records. The SVI identifies areas vulnerable to catastrophic events with four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. Food deserts were defined as neighbourhoods located one or ten miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine associations with LOS and costs after controlling for various demographic parameters.
Divorced status was significantly associated with an increased LOS (p = 0.043). Comorbidities significantly associated with an increased LOS included chronic obstructive pulmonary disease/asthma and congestive heart failure (p = 0.043 and p = 0.001, respectively). Communities with a higher density of tobacco stores were significantly associated with an increased LOS (p = 0.017). Comorbidities significantly associated with an increased TCOC included chronic obstructive pulmonary disease (p = 0.004), dementia (p = 0.048), and heart failure (p = 0.007). Increased TCOCs were significantly associated with patients who lived in food deserts (p = 0.001) and in areas with an increased density of tobacco stores (p = 0.023).
Divorced marital status was significantly associated with an increased LOS following TKA. Living in food deserts and in communities with more tobacco stores were significant risk factors for increased LOS and TCOC. Food access and ease of acquiring tobacco may both prove to be prognostic of outcome after TKA and an opportunity for intervention. Cite this article: 2021;103-B(6 Supple A):113-118.
社会决定因素（SDOHs）可能会影响接受全膝关节置换术（TKA）患者的总医疗成本（TCOC）。本研究旨在调查人口统计学数据、健康状况和 SDOHs 与该手术 30 天住院时间（LOS）和 TCOC 之间的关系。
确定了 2018 年 1 月 1 日至 2019 年 12 月 31 日期间接受 TKA 的患者。共纳入了 234 例具有完整 SDOH 数据的患者。数据来自切萨皮克地区信息系统、疾病控制中心社会脆弱性指数（SVI）、美国农业部和机构电子病历。SVI 确定了易受灾难性事件影响的地区，包括四个主题评分：社会经济地位；家庭构成和残疾；少数民族地位和语言；住房和交通。食物荒漠定义为城市和农村地区距离杂货店一英里或十英里以内的社区。进行了多元回归分析，以确定在控制各种人口统计学参数后与 LOS 和成本的关联。
离婚状况与 LOS 增加显著相关（p = 0.043）。与 LOS 增加显著相关的合并症包括慢性阻塞性肺疾病/哮喘和充血性心力衰竭（p = 0.043 和 p = 0.001）。烟草店密度较高的社区与 LOS 增加显著相关（p = 0.017）。与 TCOC 增加显著相关的合并症包括慢性阻塞性肺疾病（p = 0.004）、痴呆（p = 0.048）和心力衰竭（p = 0.007）。TCOC 增加与生活在食物荒漠（p = 0.001）和烟草店密度增加的地区的患者显著相关（p = 0.023）。
离婚婚姻状况与 TKA 后 LOS 增加显著相关。生活在食物荒漠和烟草店密度较高的社区是 LOS 和 TCOC 增加的显著危险因素。食物获取和获得烟草的便利性可能都是 TKA 后预后的预测因素，也是干预的机会。
