Do Aggregate Socioeconomic Status Factors Predict Outcomes for Total Knee Arthroplasty in a Rural Population?

Abstract

Background We sought to determine whether several pre-operative socioeconomic status (SES) variables meaningfully improve predictive models for primary total knee arthroplasty (TKA) length of stay (LOS), facility discharge, and clinically significant Veterans RAND-12 Physical Component Score (PCS) improvement. Methods We prospectively collected clinical data on 2,198 TKAs at a high-volume rural tertiary academic hospital from April 2011 through March 2016. SES variables included race/ethnicity, living alone, education, employment, and household income, along with numerous adjusting variables. We determined individual SES predictors and whether the inclusion of all SES variables contributed to each 10-fold cross-validated area under the model’s area under the receiver operating characteristic (AUC). We also used 1000-fold bootstrapping methods to determine whether the SES and non-SES models were statistically different from each other. Results At least 1 SES predicted each outcome. Ethnic minority patients and those with incomes<$35,000 predicted longer LOS. Ethnic minority patients, the unemployed, and those living alone predicted facility discharge. Unemployed patients were less likely to achieve PCS improvement. Without the 5 SES variables, the AUC values of the LOS, discharge, and PCS models were 0.74 (95% CI 0.72–0.77, “acceptable”; 0.86 (CI 0.84–0.87, “excellent”); and 0.80 (CI 0.78–0.82, “excellent”), respectively. Including the 5 SES variables, the ten-fold cross-validated and bootstrapped AUC values were 0.76 (CI 0.74–0.79); 0.87 (CI 0.85–0.88); and 0.81 (0.79–0.83), respectively. Conclusions We developed validated predictive models for outcomes after TKA. Although inclusion of multiple SES variables provided statistical predictive value in our models, the amount of improvement may not be clinically meaningful.

Association of social support with patient-reported outcomes after joint replacement: a systematic review and meta-analysis

“…In meta-analysis, the presence of social support was found to have a beneficial effect of these studies were at high risk of bias on ≥1 domain. Outcomes assessed included SF-36 or SF-12 total or subscale scores 26,31,37,45,47,48,53,56,58,59,63,69 , Nottingham Health Profile 40 , EQ-5D 41,43,50,74 , Instrumental Activity of Daily Living 42 , Indicators of the Rehabilitation Status questionnaire (IRES) pain subscale 35 , and Yale Physical Activity Score 33 . One study reported that being unmarried was associated with better self-care and transfer on the Functional Independence Measure but not locomotion 27 and another study found that a lack of family support was associated with better SF-36 Mental Component scores at 3 months 56 .…”

Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study

“…We referenced similar studies in orthopaedics that investigated the impact of patient factors on outcomes to determine which patient data to collect. 7,8 Demographic data included age, sex, ethnicity (white, black, Asian, and other/unknown), and insurance status (Medicare, commercial/self-pay, Medicaid, and other/unknown). Psychosocial characteristics included a history of depression, dementia, psychosis, obesity (body mass index [BMI], 30 to 40/>40 kg/m 2 ), smoking, alcoholism, drug abuse, or opioid abuse as indicated by International Classification of Diseases (ICD)-9 codes.…”

Patient outcomes after total hip arthroplasty in extreme elderly patients older than 80 years

“…We also included pre-and postoperative, prospectively collected, PROMs in the form of physical component summary (PCS) and mental component summary (MCS) scores from the Patient-Reported Outcome Measurement Information System (PROMIS-10) metric or from the Veterans-RAND 12-item health survey (VR-12) converted to PROMIS-10 via a crosswalk used previously in the arthroplasty literature. 19,20 A clinically significant PCS improvement was defined as an improvement of more than 5 points, in accordance with previous arthroplasty literature. [20][21][22] Perioperative outcomes that were extracted included length of stay (LOS), and discharge disposition.…”

“…19,20 A clinically significant PCS improvement was defined as an improvement of more than 5 points, in accordance with previous arthroplasty literature. [20][21][22] Perioperative outcomes that were extracted included length of stay (LOS), and discharge disposition.…”