Gordon Adam M, Sheth Bhavya K, Conway Charles A, Horn Andrew R, Sadeghpour Ramin, Choueka Jack
Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, NY, USA.
Questrom School of Business, Boston University, Boston, MA, USA.
HSS J. 2024 Nov;20(4):482-489. doi: 10.1177/15563316231195299. Epub 2023 Sep 12.
Social determinants of health are prognostic indicators for patients undergoing orthopedic procedures.
Using the area deprivation index (ADI), a validated, weighted index of material deprivation and poverty (a 0%-to-100% scale, with higher percentages indicating greater disadvantage), we sought to evaluate whether there are associations in shoulder arthroplasty patients between higher ADI and rates of (1) medical complications, (2) emergency department (ED) utilizations, (3) readmissions, and (4) costs.
We queried the PearlDiver nationwide database for patients who had undergone primary shoulder arthroplasty from 2010 to 2020. Patients from regions associated with high ADI (95%+) were 1:1 propensity matched to a comparison group by age, sex, and Elixhauser Comorbidity Index. This yielded 49,440 patients in total. Outcomes included 90-day complications, ED utilizations, readmissions, and costs. Logistic regression models computed odds ratios (ORs) of ADI on the dependent variables. values of < .05 were significant.
Patients from high ADI regions showed higher rates and odds of complications than those in the comparison group (10.84% vs 9.45%; OR: 1.10), including acute kidney injuries (1.73% vs 1.38%; OR: 1.23), urinary tract infections (3.19% vs 2.80%; OR: 1.13), and respiratory failures (0.49% vs 0.33%; OR: 1.44), but not increased ED visits (2.66% vs 2.71%; OR: 0.99) or readmissions (3.07% vs 2.96%; OR: 1.03). Patients from high ADI regions incurred higher costs on day of surgery ($8251 vs $7337) and at 90 days ($10,999 vs $9752).
This 10-year retrospective database study found that patients from high ADI regions undergoing primary shoulder arthroplasty had increased rates of all 90-day medical complications, suggesting that measures of social determinants of health could inform health care policy and improve post-discharge care in these patients.
健康的社会决定因素是接受骨科手术患者的预后指标。
使用地区贫困指数（ADI），这是一种经过验证的物质剥夺和贫困加权指数（范围为0%至100%，百分比越高表明劣势越大），我们试图评估在肩关节置换术患者中，较高的ADI与以下方面的发生率之间是否存在关联：（1）医疗并发症，（2）急诊科就诊率，（3）再入院率，以及（4）费用。
我们查询了PearlDiver全国数据库中2010年至2020年接受初次肩关节置换术的患者。将来自高ADI地区（95%以上）的患者按年龄、性别和埃利克斯豪泽合并症指数与一个对照组进行1:1倾向匹配。总共得到49440名患者。结局包括90天并发症、急诊科就诊率、再入院率和费用。逻辑回归模型计算ADI对因变量的比值比（OR）。P值<0.05具有统计学意义。
来自高ADI地区的患者并发症发生率和几率高于对照组（10.84%对9.45%；OR：1.10），包括急性肾损伤（1.73%对1.38%；OR：1.23）、尿路感染（3.19%对2.80%；OR：1.13）和呼吸衰竭（0.49%对0.33%；OR：1.44），但急诊科就诊率（2.66%对2.71%；OR：0.99）或再入院率（3.07%对2.96%；OR：1.03）没有增加。来自高ADI地区的患者在手术当天（8251美元对7337美元）和90天时（10999美元对9752美元）产生的费用更高。
这项为期10年的回顾性数据库研究发现，来自高ADI地区接受初次肩关节置换术的患者90天内所有医疗并发症的发生率均有所增加，这表明健康的社会决定因素指标可为医疗保健政策提供参考，并改善这些患者出院后的护理。
