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Social determinants of health in patients undergoing hemiarthroplasty: are they associated with medical complications, healthcare utilization, and payments for care?

  • Trauma Surgery
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Abstract

Introduction

Social determinants of health (SDOH) have previously been shown to impact orthopedic surgery outcomes. This study assessed whether greater socioeconomic disadvantage in patients undergoing hemiarthroplasty following femoral neck fracture was associated with differences in (1) medical complications, (2) emergency department (ED) utilization, (3) readmission rates, and (4) payments for care.

Methods

A US nationwide database was queried for hemiarthroplasties performed between 2010 and 2020. Area Deprivation Index (ADI), a validated measure of socioeconomic disadvantage reported on a scale of 0–100, was used to compare two cohorts of greater and lesser deprivation. Patients undergoing hemiarthroplasty from high ADI (95% +) were 1:1 propensity score matched to a comparison group of lower ADI (0–94%) while controlling for age, sex, and Elixhauser Comorbidity Index. This yielded 75,650 patients evenly distributed between the two cohorts. Outcomes studied were 90-day medical complications, ED utilizations, readmissions, and payments for care. Multivariate logistic regression models were utilized to calculate odds ratios (ORs) of the relationship between ADI and outcomes. p Values < 0.05 were significant.

Results

Patients of high ADI developed greater medical complications (46.74% vs. 44.97%; OR 1.05, p = 0.002), including surgical site infections (1.19% vs. 1.00%; OR 1.20, p = 0.011), cerebrovascular accidents (1.64% vs. 1.41%; OR 1.16, p = 0.012), and respiratory failures (2.27% vs. 2.02%; OR 1.13, p = 0.017) compared to patients from lower ADIs. Although comparable rates of ED visits (2.92% vs. 2.86%; OR 1.02, p = 0.579), patients from higher ADI were readmitted at diminished rates (10.57% vs. 11.06%; OR 0.95, p = 0.027). Payments were significantly higher on the day of surgery ($7,570 vs. $5,974, p < 0.0001), as well as within 90 days after surgery ($12,700 vs. $10,462, p < 0.0001).

Conclusions

Socioeconomically disadvantaged patients experience increased 90-day medical complications and payments, similar ED utilizations, and decreased readmissions. These findings can be used to inform healthcare providers to minimize disparities in care.

Level of evidence

III.

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Data availability

The data from this study are not openly available as they are derived from a subscription data source but are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors did not receive support from any organization for the submitted work.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA

    Joydeep Baidya, Adam M. Gordon, Patrick P. Nian, Jake Schwartz, Ivan J. Golub, Amr A. Abdelgawad & Kevin K. Kang

  2. College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Joydeep Baidya & Patrick P. Nian

  3. Questrom School of Business, Boston University, Boston, MA, USA

    Adam M. Gordon

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  1. Joydeep Baidya
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Correspondence to Adam M. Gordon.

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This study was performed in line with the principles of the Declaration of Helsinki.

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This study was determined to be exempt from the Institutional Review Board (IRB) of Maimonides Medical Center.

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Baidya, J., Gordon, A.M., Nian, P.P. et al. Social determinants of health in patients undergoing hemiarthroplasty: are they associated with medical complications, healthcare utilization, and payments for care?. Arch Orthop Trauma Surg 143, 7073–7080 (2023). https://doi.org/10.1007/s00402-023-05045-z

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