The Impact of Socioeconomic Factors on 90-day Postoperative Readmissions and Cost in Shoulder Arthroplasty Patients

• Published in: Journal of shoulder and elbow surgery 2024-11
• Main Authors: Bethell, Mikhail A., Mahoney, Hannah R., Adu-Kwarteng, Kwabena, Kiwinda, Lulla V., Clark, Amy G., Hammill, Bradley G., Boachie-adjei, Yaw D., Anakwenze, Oke, Péan, Christian A.
• Format: Article
• Language: English
• Subjects: area deprivation index; costs; disparities; readmission; Shoulder arthroplasty; socioeconomic status
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2024.09.011

Understanding the impact of Social Drivers of Health (SDOH) on shoulder arthroplasty is pivotal for the development of equitable value-based payment models that enhance the quality of patient care. This investigation aims to understand the influence of Area Deprivation Index (ADI) on hospital admissions, readmissions, and associated costs post-shoulder arthroplasty. We conducted an analysis using US Medicare claims data from 2019 to 2021, identifying patients who received shoulder arthroplasty in either an inpatient or outpatient setting using Current Procedural Terminology (CPT) codes. Our primary outcomes were 90-day unplanned readmissions and post-procedure 90-day care costs. The ADI was our primary exposure variable, calculated at the census block level. Our analysis adjusted for multiple factors using a stepwise modeling approach including patient demographics, 29 Elixhauser comorbid conditions, Medicaid-dual eligibility, and end-stage renal disease status using logistic regression models. A total of 145,435 patients were included in our study. The average age of patients in our cohort was 74.5 years old, with 59.5% being female. Patients in the high ADI group had a higher readmission rate than the lowest ADI group (8.5% vs. 6.0%, p