Social determinants of health in total knee arthroplasty

Abstract

Aims Social determinants of health (SDOHs) may contribute to the total cost of care (TCOC) for patients undergoing total knee arthroplasty (TKA). The aim of this study was to investigate the association between demographic data, health status, and SDOHs on 30-day length of stay (LOS) and TCOC after this procedure. Methods Patients who underwent TKA between 1 January 2018 and 31 December 2019 were identified. A total of 234 patients with complete SDOH data were included. Data were drawn from the Chesapeake Regional Information System, the Centers for Disease Control social vulnerability index (SVI), the US Department of Agriculture, and institutional electronic medical records. The SVI identifies areas vulnerable to catastrophic events with four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. Food deserts were defined as neighbourhoods located one or ten miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine associations with LOS and costs after controlling for various demographic parameters. Results Divorced status was significantly associated with an increased LOS (p = 0.043). Comorbidities significantly associated with an increased LOS included chronic obstructive pulmonary disease/asthma and congestive heart failure (p = 0.043 and p = 0.001, respectively). Communities with a higher density of tobacco stores were significantly associated with an increased LOS (p = 0.017). Comorbidities significantly associated with an increased TCOC included chronic obstructive pulmonary disease (p = 0.004), dementia (p = 0.048), and heart failure (p = 0.007). Increased TCOCs were significantly associated with patients who lived in food deserts (p = 0.001) and in areas with an increased density of tobacco stores (p = 0.023). Conclusion Divorced marital status was significantly associated with an increased LOS following TKA. Living in food deserts and in communities with more tobacco stores were significant risk factors for increased LOS and TCOC. Food access and ease of acquiring tobacco may both prove to be prognostic of outcome after TKA and an opportunity for intervention. Cite this article: Bone Joint J 2021;103-B(6 Supple A):113–118.

Socioeconomic status, mental health, and nutrition are the principal traits for low back pain phenotyping: Data from the osteoarthritis initiative

“…Social determinants of health influence the occurrence or progression of many diseases, such as hypertension, 21 joint degeneration, 22 breast cancer, 23 and kidney disease. 24 In this study, those with lower income and education level were more likely to have severe back pain at enrollment and over 8 year.…”

Social Determinants of Health

“…Bradywood et al (2021) found the need to add questions to aid in discharge planning among patients with spine injury related to social support available after hospital discharge and finances for medications. Delanois et al (2021) found marital status and zip codes with food deserts and increased number of tobacco stores where patients lived had higher total cost of care and length of stay following total knee arthroplasty. With the shift of orthopaedic procedures to ambulatory surgical centers, identifying ideal candidates for appropriate settings and addressing patient-specific factors are imperative (Delanois et al, 2021).…”

“…Delanois et al (2021) found marital status and zip codes with food deserts and increased number of tobacco stores where patients lived had higher total cost of care and length of stay following total knee arthroplasty. With the shift of orthopaedic procedures to ambulatory surgical centers, identifying ideal candidates for appropriate settings and addressing patient-specific factors are imperative (Delanois et al, 2021). With appropriate social interventions, medical care can be expanded to marginalized patient groups and surgical interventions can be safely performed without complications (Delanois et al, 2021).…”

Patient Adherence Following Knee Surgery: Evidence-Based Practices to Equip Patients for Success

“…Patients who lack financial resources or adequate social support often fail to pursue recommended treatments, fill prescribed medications, and/or attend scheduled appointments due to concern over costs. 9,31 In addition, low health literacy puts patients at a higher risk for unanticipated medical bills 32 , perpetuating financial impacts on adherence. 31,33 Adherence has also been well documented to be disproportionately lower among racial and ethnic minorities.…”