Pilc Emily M, Ahiarakwe Uzoma, Anand Kirin, Cyrus John, Golladay Gregory J, Patel Nirav K
Eastern Virginia Medical School, Norfolk, Virginia.
Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia.
J Arthroplasty. 2025 May;40(5):1358-1366.e2. doi: 10.1016/j.arth.2024.10.120. Epub 2024 Oct 28.
Socioeconomic status (SES)-an individual or group's social standing or class, as measured by education, income, and occupation-has been associated with poor surgical outcomes in orthopaedics. Total knee arthroplasty and total hip arthroplasty (THA) are the most commonly investigated orthopaedic surgeries regarding SES and patient-reported outcome measures (PROMs), yet the results are contradictory. The aim of this systematic review was to assess the impact of SES on PROMs following total joint arthroplasty (TJA).
We performed a literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines utilizing MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Library from database inception (1971, 1974, and 1996, respectively) to August 2, 2023, to identify studies investigating SES and PROMs in adults undergoing primary elective TJA. Studies were included if they evaluated one of three SES variables (income, education, or employment status) and reported at least one-year scores using a validated PROM. There were two reviewers who independently screened studies and extracted data.
There were 16 studies included in this systematic review. A total of 55,875 arthroplasties, including 24,055 total knee arthroplasties and 31,820 THAs, were analyzed. Of the studies, eight evaluated income, 15 evaluated education, and two evaluated employment status. The majority of studies investigating income found a statistically significant association between lower income and worse postoperative PROMs. There were ten studies, involving 90% of all patients from the included education studies, which found a statistically significant association between education and postoperative PROMs. There were two studies that found unemployed THA patients had lower improvements in PROMs compared to employed and retired patients.
Our systematic review found several significant associations between income, education, employment, and PROMs after TJA. Providers should pay special attention to lower-income, less educated, and unemployed patients. These patients may benefit from targeted interventions to achieve substantial clinical benefit after TJA.
社会经济地位（SES）——通过教育、收入和职业衡量的个人或群体的社会地位或阶层——与骨科手术的不良结果相关。全膝关节置换术和全髋关节置换术（THA）是关于SES和患者报告结局指标（PROMs）研究最多的骨科手术，但结果相互矛盾。本系统评价的目的是评估SES对全关节置换术（TJA）后PROMs的影响。
我们按照系统评价和Meta分析的首选报告项目指南进行文献检索，使用MEDLINE（Ovid）、EMBASE（Ovid）和Cochrane图书馆，检索时间从数据库建立之初（分别为1971年、1974年和1996年）至2023年8月2日，以识别调查接受初次择期TJA的成年人中SES和PROMs的研究。如果研究评估了三个SES变量（收入、教育或就业状况）之一，并使用经过验证的PROM报告了至少一年的评分，则纳入该研究。有两位评价者独立筛选研究并提取数据。
本系统评价纳入了16项研究。共分析了55875例关节置换术，包括24055例全膝关节置换术和31820例THA。在这些研究中，8项评估了收入，15项评估了教育，2项评估了就业状况。大多数调查收入的研究发现低收入与术后较差的PROMs之间存在统计学显著关联。有10项研究（涉及纳入的教育研究中90%的患者）发现教育与术后PROMs之间存在统计学显著关联。有两项研究发现，与就业和退休患者相比，失业的THA患者在PROMs方面的改善较低。
我们的系统评价发现TJA后收入、教育、就业与PROMs之间存在若干显著关联。医疗服务提供者应特别关注低收入、受教育程度低和失业的患者。这些患者可能受益于有针对性的干预措施，以在TJA后获得实质性的临床益处。
