Rahman Tahsin M, Hennekes Mary, Mehaidli Ali, Shaw Jonathan H, Silverton Craig D
From the Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI.
J Am Acad Orthop Surg. 2024 Feb 15;32(4):169-177. doi: 10.5435/JAAOS-D-23-00368. Epub 2023 Dec 11.
The purpose of this study was to investigate the effect of various social determinants of health on outcomes and dispositions after total knee arthroplasty (TKA).
A retrospective review was conducted on 14,462 consecutive TKA procedures between 2013 and 2021 at a multicenter hospital system. Data abstraction was done by inquiry to the Michigan Arthroplasty Registry Collaborative Quality Initiative. Data points requested included basic demographics, marital status, race, insurance status, socioeconomic status measured by the Area of Deprivation Index, perioperative course, and incidence of emergency department (ED) visits and readmissions within 3 months of surgery. Subsequent multivariate analyses were conducted.
Unmarried patients required markedly greater lengths of hospital stay and had an increased rate of discharge to skilled nursing facilities and a higher likelihood of any purpose ED visit within 90 days of surgery compared with married patients, who had a significantly greater rate of same-day discharge ( P < 0.001). Race did not markedly correlate with outcomes. Medicare patients showed a greater rate of same-day discharge, nonhome discharge, and 90-day ED visits compared with privately insured patients ( P < 0.001). Medicaid patients were more likely than privately insured patients to have a 90-day ED visit ( P < 0.001). Socioeconomic status had a minimal clinical effect on all studied outcomes.
Social factors are important considerations in understanding outcomes after TKA. Additional investigations are indicated in identifying at-risk patients and subsequent optimization of these patients.
本研究的目的是调查各种健康社会决定因素对全膝关节置换术（TKA）后结果和处置情况的影响。
对一家多中心医院系统在2013年至2021年期间连续进行的14462例TKA手术进行回顾性研究。通过向密歇根关节置换登记协作质量倡议组织查询来进行数据提取。所需的数据点包括基本人口统计学信息、婚姻状况、种族、保险状况、用贫困指数衡量的社会经济状况、围手术期过程以及术后3个月内急诊就诊和再入院的发生率。随后进行多变量分析。
与已婚患者相比，未婚患者住院时间明显更长，出院至专业护理机构的比例增加，且术后90天内因任何原因急诊就诊的可能性更高，而已婚患者当日出院率显著更高（P<0.001）。种族与结果没有明显相关性。与私人保险患者相比，医疗保险患者当日出院率、非回家出院率和90天急诊就诊率更高（P<0.001）。医疗补助患者比私人保险患者更有可能在90天内急诊就诊（P<0.001）。社会经济状况对所有研究结果的临床影响最小。
社会因素是理解TKA术后结果时的重要考虑因素。需要进一步开展研究以识别高危患者并对这些患者进行后续优化。
