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Neighborhood Socioeconomic Disadvantage is Associated with Increased Healthcare Utilization After Septic and Aseptic Revision Total Hip Arthroplasty.
Jevnikar, Benjamin E; Huffman, Nickelas; Pasqualini, Ignacio; Zhang, Chao; Klika, Alison K; Deren, Matthew E.
Afiliación
  • Jevnikar BE; Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
  • Huffman N; Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
  • Pasqualini I; Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
  • Zhang C; Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
  • Klika AK; Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
  • Deren ME; Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH, USA.
J Arthroplasty ; 2024 Sep 16.
Article en En | MEDLINE | ID: mdl-39293696
ABSTRACT

BACKGROUND:

A greater Area Deprivation Index (ADI), a tool that gauges socioeconomic disadvantage at the neighborhood level, is associated with worse healthcare outcomes following primary total hip arthroplasty (THA). However, its association with revision THA (rTHA) is unknown. This study aimed to determine the association between ADI and rates of postoperative healthcare resource utilization following rTHA.

METHODS:

A total of 996 patients who underwent rTHA between 2016 and 2022 were enrolled in a prospective study. The primary outcomes assessed were non-home discharge disposition (DD), length of stay (LOS) ≥ 3 days, 90-day emergency department (ED) visits, and 90-day hospital readmissions. The ADI was calculated using the patient's home address at the time of surgery, with greater ADI indicating greater socioeconomic disadvantage. We evaluated the mediation effect of patient race on ADI and postoperative healthcare utilization using a multivariable logistic regression model.

RESULTS:

A higher median ADI was revealed for patients who experienced non -home discharge (P = 0.001), extended LOS (P < 0.001), and ED readmission within 90-days of surgery (P = 0.045). When comparing septic versus aseptic rTHA patients, there were significant differences in healthcare resource utilization but no difference in ADI between the two groups. For aseptic rTHA, ADI significantly mediated the effect of race on both non-home DD and LOS ≥ 3 (41% and 46% mediation, respectively). In septic rTHA, ADI mediated 31.1% of the effect of race on non-home DD, but showed minimal mediation effect on LOS. The mediation effect of ADI on ED admission and hospital readmission was minimal for both groups

CONCLUSION:

Higher ADI scores are associated with increased healthcare utilization after rTHA, including longer hospital stays and more non-home discharges. The ADI significantly mediates the effect of race on these outcomes, particularly in aseptic rTHA cases, suggesting that neighborhood socioeconomic factors play a crucial role in previously observed racial disparities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Arthroplasty Asunto de la revista: ORTOPEDIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Arthroplasty Asunto de la revista: ORTOPEDIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos