Jevnikar Benjamin E, Huffman Nickelas, Pasqualini Ignacio, Zhang Chao, Klika Alison K, Deren Matthew E, Piuzzi Nicolas S
Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio.
J Arthroplasty. 2025 Mar;40(3):550-558.e2. doi: 10.1016/j.arth.2024.09.014. Epub 2024 Sep 16.
A greater area deprivation index (ADI), a tool that gauges socioeconomic disadvantage at the neighborhood level, is associated with worse health care outcomes following primary total hip arthroplasty. However, its association with revision total hip arthroplasty (rTHA) is unknown. This study aimed to determine the association between ADI and rates of postoperative health care resource utilization following rTHA.
A total of 996 patients who underwent rTHA between 2016 and 2022 were enrolled in a prospective study. The primary outcomes assessed were nonhome discharge disposition (DD), length of stay (LOS) ≥ three days, 90-day emergency department (ED) visits, and 90-day hospital readmissions. The ADI was calculated using the patient's home address at the time of surgery, with greater ADI indicating greater socioeconomic disadvantage. We evaluated the mediation effect of patient race on ADI and postoperative health care utilization using a multivariable logistic regression model.
A higher median ADI was revealed for patients who experienced nonhome discharge (P = 0.001), extended LOS (P < 0.001), and ED readmission within 90 days of surgery (P = 0.045). When comparing septic versus aseptic rTHA patients, there were significant differences in health care resource utilization but no difference in ADI between the two groups. For aseptic rTHA, ADI significantly mediated the effect of race on both nonhome DD and LOS ≥ 3 (41 and 46% mediation, respectively). In septic rTHA, ADI mediated 31.1% of the effect of race on nonhome DD, but showed minimal mediation effect on LOS. The mediation effect of ADI on ED admission and hospital readmission was minimal for both groups.
Higher ADI scores are associated with increased health care utilization after rTHA, including longer hospital stays and more nonhome discharges. The ADI significantly mediates the effect of race on these outcomes, particularly in aseptic rTHA cases, suggesting that neighborhood socioeconomic factors play a crucial role in previously observed racial disparities.
更大区域贫困指数（ADI）是一种衡量社区层面社会经济劣势的工具，与初次全髋关节置换术后较差的医疗保健结果相关。然而，其与翻修全髋关节置换术（rTHA）的关联尚不清楚。本研究旨在确定ADI与rTHA术后医疗保健资源利用率之间的关联。
共有996例在2016年至2022年间接受rTHA的患者纳入一项前瞻性研究。评估的主要结局为非家庭出院处置（DD）、住院时间（LOS）≥3天、90天急诊科（ED）就诊以及90天再入院。ADI使用手术时患者的家庭住址计算，ADI越高表明社会经济劣势越大。我们使用多变量逻辑回归模型评估患者种族对ADI和术后医疗保健利用的中介效应。
经历非家庭出院（P = 0.001）、延长住院时间（P < 0.001）以及术后90天内ED再入院（P = 0.045）的患者，其ADI中位数更高。比较感染性与无菌性rTHA患者时，两组在医疗保健资源利用方面存在显著差异，但ADI无差异。对于无菌性rTHA，ADI显著介导了种族对非家庭DD和LOS≥3的影响（分别为41%和46%的中介效应）。在感染性rTHA中，ADI介导了种族对非家庭DD影响的31.1%，但对LOS的中介效应极小。两组中ADI对ED入院和再入院的中介效应均极小。
较高的ADI评分与rTHA术后医疗保健利用率增加相关，包括更长的住院时间和更多的非家庭出院。ADI显著介导了种族对这些结局的影响，尤其是在无菌性rTHA病例中，这表明社区社会经济因素在先前观察到的种族差异中起关键作用。
