Social Determinants of Health Disparities Impact Postoperative Complications in Patients Undergoing Total Shoulder Arthroplasty

Abstract

Background Postoperative complications are a concern for surgeons due to worse outcomes and increased cost. It has been shown that social determinants of health disparities (SDHD) are associated with higher rates of postoperative complications. Understanding the role SDHD plays in patient’s health can help prepare providers to optimize patients’ conditions prior to surgery and improve postoperative care. The purpose of this study was to compare the postoperative complication rates between patients undergoing total shoulder arthroplasty (TSA) with a past medical history of SDHD with a control group without SDHD diagnoses. Methods A retrospective cohort analysis was conducted using a national insurance claims database. Using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes patients who underwent primary TSA with at least two years of follow-up in the database were identified. The SDHD and control groups were matched and analyzed using multivariable analysis for 90-day medical complications and 2-year surgical complications. Results A total of 120,367 patients underwent TSA between 2010-2019: 110,822 patients in control group and 9,394 in SDHD group. SDHD group had significantly longer length of stay (mean [SD]; Control = 1.99 days [1.39] vs SDHD = 3.84 days [18.32]; p<0.001) along with significantly higher odds ratios for 90-day medical complications including heart failure (OR: 3.71; p<0.001), cerebrovascular accident (OR: 2.48; p<0.001), renal failure (OR: 2.91; p<0.001), death (OR: 3.32; p<0.001), deep vein thrombosis (OR: 3.16; p<0.001), pulmonary embolism (OR: 1.95; p<0.001), pneumonia (OR: 2.84; p<0.001), sepsis (OR: 4.94; p<0.001), and urinary tract infection (OR: 2.60; p<0.001). Additionally, the SDHD group had a significantly higher odds ratio for revision surgery within 2-years following TSA (OR: 1.45; p<0.001). Conclusion This study highlights the negative impact of SDHD on patient outcomes following TSA including a higher rate of postoperative complications within 90-days and revision surgery within 2-years. Additionally, patients with a history of SDHD had a significantly longer length of hospital stay than patients without SDHD. Quantifying the risk of complications and differences in length of stay for TSA patients with a history of SDHD are important in determining value-based payment models and risk stratification to optimize patient care.