Patients From Medically Underserved Areas Are at Increased Risk for Nonhome Discharge and Emergency Department Return After Total Joint Arthroplasty

Holbert, S. Elliott; Cheema, Minahil; Brennan, Jane C; MacDonald, James; King, Paul J.; Turcotte, Justin

doi:10.1016/j.arth.2021.12.033

Cited by 11 publications

(15 citation statements)

References 18 publications

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“…Among the seven studies that evaluated the association between social deprivation and adverse events, there was disagreement about whether social deprivation was associated with readmission and various complications. However, all seven studies evaluating discharge reported higher nonhome discharge for patients with higher levels of social deprivation [11, 14, 19, 27, 36, 44, 56]. These studies were all retrospective, and each had a study population of more than 10,000 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Our secondary goal was to investigate the association between social deprivation with adverse events and PROMs after TJA. Seven articles evaluated the association between social deprivation and adverse events [11,14,19,27,36,44,56] (Table 4). Six articles reported on the relationship between PROMs and social deprivation [10,11,19,29,49,50] (Table 5).…”

Section: Primary and Secondary Study Outcomesmentioning

confidence: 99%

“…discharge for patients with higher levels of social deprivation [11,14,19,27,36,44,56]. These studies were all retrospective, and each had a study population of more than 10,000 participants.…”

Section: Adverse Eventsmentioning

confidence: 99%

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Is Social Deprivation Associated With Usage, Adverse Events, and Patient-reported Outcome Measures in Total Joint Arthroplasty? A Systematic Review

Karimi

Burkhart

Hecht

et al. 2022

Clin Orthop Relat Res

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BackgroundTo capture various social determinants of health, recent analyses have used comprehensive measures of socioeconomic disadvantage such as deprivation and vulnerability indices. Given that studies evaluating the effects of social deprivation on total joint arthroplasty (TJA) have yielded mixed results, a systematic review of this relationship might help answer questions about usage, complications, and results after surgery among patients in different socioeconomic groups and help guide targeted approaches to ensure health equity.Questions/purposesWe asked: How is social deprivation associated with TJA (1) usage, (2) adverse events including discharge deposition and length of stay, and (3) patient-reported outcome measures (PROMs)?MethodsA comprehensive review of the PubMed, EBSCO host, Medline, and Google Scholar electronic databases was conducted to identify all studies that evaluated social deprivation and TJA between January 1, 2000, and March 1, 2022. Studies were included if they evaluated comprehensive measures of socioeconomic deprivation rather than individual social determinants of health. Nineteen articles were included in our final analysis with a total of 757,522 patients. In addition to characteristics of included studies (such as patient population, procedure evaluated, and utilized social deprivation metric), we recorded TJA usage, adverse events, and PROM values as reported by each article. Two reviewers independently evaluated the quality of included studies using the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean ± SD MINORS score was 13 ± 1 of 16, with higher scores representing better study quality. All the articles included are noncomparative studies. Given the heterogeneity of the included studies, a meta-analysis was not performed and results were instead presented descriptively.ResultsAlthough there were inconsistencies among the included articles, higher levels of social deprivation were associated with lower TJA usage even after controlling for various confounding variables. Similarly, there was agreement among studies regarding higher proportion of nonhome discharge for patients with more social deprivation. Although there was limited agreement across studies regarding whether patients with more social deprivation had differences in their baseline and postoperative PROMs scores, patients with more social deprivation had lower improvements from baseline for most of the included articles.ConclusionThese findings encourage continued efforts focusing on appropriate patient education regarding expectations related to functional improvement and the postoperative recovery process, as well as resources available for further information and social support. We suggest linking patient data to deprivation measures such as the Area Deprivation Index to help encourage shared decision-making strategies that focus on health literacy and common barriers related to access. Given the potential influence social deprivation may have on the outcome and utilization of TJ...

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Section: Resultsmentioning

confidence: 99%

Section: Primary and Secondary Study Outcomesmentioning

confidence: 99%

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Is Social Deprivation Associated With Usage, Adverse Events, and Patient-reported Outcome Measures in Total Joint Arthroplasty? A Systematic Review

Karimi

Burkhart

Hecht

et al. 2022

Clin Orthop Relat Res

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show abstract

“…Holbert et al. utilized the Centers for Disease Control Social Vulnerability Index to evaluate the social vulnerability of patients undergoing a TJA with regard to home discharge and 90-day ED returns [ 29 ]. They found that patients with nonhome discharge had higher overall social vulnerability and greater vulnerability within the 4 themes evaluated by the Social Vulnerability Index including socioeconomic status, household composition and disability, minority status and language, and housing and transportation.…”

Section: Discussionmentioning

confidence: 99%

“…They found that patients with nonhome discharge had higher overall social vulnerability and greater vulnerability within the 4 themes evaluated by the Social Vulnerability Index including socioeconomic status, household composition and disability, minority status and language, and housing and transportation. They also demonstrated that patients returning to the ED within 90 days had lower vulnerability with socioeconomic, household composition, and disability factors [ 29 ]. These findings reiterate the fact that a multitude of factors underlie the disparities in health care.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Outcomes of Total Joint Arthroplasty at a Single Institution: Have We Made Progress?

Holbert¹,

Brennan²,

Johnson³

et al. 2023

Arthroplasty Today

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

Baidya,

Gordon,

Nian

et al. 2023

Arch Orthop Trauma Surg

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Patients From Medically Underserved Areas Are at Increased Risk for Nonhome Discharge and Emergency Department Return After Total Joint Arthroplasty

Cited by 11 publications

References 18 publications

Is Social Deprivation Associated With Usage, Adverse Events, and Patient-reported Outcome Measures in Total Joint Arthroplasty? A Systematic Review

Is Social Deprivation Associated With Usage, Adverse Events, and Patient-reported Outcome Measures in Total Joint Arthroplasty? A Systematic Review

Racial Disparities in Outcomes of Total Joint Arthroplasty at a Single Institution: Have We Made Progress?

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

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