Purpose
To investigate the impact social determinants of health (SDOH) have on National Institutes
of Health Patient-Reported Outcomes Measurement Information System (PROMIS) computer
adaptive test scores and postoperative health care use in patients who undergo rotator
cuff repair (RCR).
Methods
All patients who underwent RCR surgery by 3 shoulder and/or sports medicine fellowship-trained
orthopaedic surgeons between July 2017 and January 2020 were included. The electronic
medical record (EMR) was used to identify SDOH for each patient. PROMIS computer adaptive
test measures of Upper Extremity function, Pain Interference, and Depression were
completed preoperatively and postoperatively (6 months and 1 year). Postoperative
health care use (clinical visits, virtual encounters, imaging encounters, and physical
therapy visits) were recorded as well. Univariate associations, multiple linear regressions,
and Wilcoxon rank-sum tests were used to analyze mean differences between patient
groups based on SDOH.
Results
Three hundred thirty-eight patients who underwent RCR were included. Patients who
were Black, in lower median household income quartiles, had public insurance, and
female reported lower PROMIS scores compared with their counterparts. Smokers and
White patients attended fewer postoperative office visits whereas Black patients had
more physical therapy and nonvisit encounters compared with their respective counterparts.
Conclusions
Black race and lower socioeconomic status are associated with worse function and pain
outcomes post-RCR compared with White race. Similarly, Black race and positive smoking
status are associated with differential use of health care following RCR. Further
attention may be required for these patients to address health care disparities.
Level of Evidence
III, retrospective cohort study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Social determinants of health in the United States: Addressing major health inequality trends for the nation, 1935-2016.Int J MCH AIDS. 2017; 6: 139-164
- Outcome measures in clinical ACL studies: An analysis of highly cited level I trials.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1517-1527
- The impact of socioeconomic status on outcomes in orthopaedic surgery.J Bone Joint Surg Am. 2020; 102: 428-444
- Social determinants of health and patient-reported outcomes following total hip and knee arthroplasty in veterans.J Arthroplasty. 2020; 35: 2357-2362
- Black race as a social determinant of health and outcomes after lumbar spinal fusion surgery: A multistate analysis, 2007 to 2014.Spine (Phila Pa 1976). 2020; 45: 701-711
- How do race and insurance status affect the care of pediatric anterior cruciate ligament injuries?.Clin J Sport Med. 2020; 30: e201-e206
- How comprehensive and efficient are patient-reported outcomes for rotator cuff tears?.Orthop J Sports Med. 2017; 52325967117693223
- Editorial Commentary: Are we comparing apples to oranges? The need for standardized outcomes reporting in orthopaedic surgery.Arthroscopy. 2017; 33: 484-485
- Patient compliance with electronic patient reported outcomes following shoulder arthroscopy.Arthroscopy. 2017; 33: 1940-1946
- Patient Reported Outcomes Measurement Information System (PROMIS) in the upper extremity: The future of outcomes reporting?.J Shoulder Elbow Surg. 2017; 26: 352-357
- Outcomes after patch use in rotator cuff repair.Arthroscopy. 2016; 32: 1676-1690
- The responsiveness of patient-reported outcome tools in shoulder surgery is dependent on the underlying pathological condition.Am J Sports Med. 2019; 47: 241-247
- PROMIS for Orthopaedic outcomes measurement.J Am Acad Orthop Surg. 2016; 24: 744-749
- Psychometric evaluation of the PROMIS Physical Function Computerized Adaptive Test in comparison to the American Shoulder and Elbow Surgeons score and Simple Shoulder Test in patients with rotator cuff disease.J Shoulder Elbow Surg. 2015; 24: 1961-1967
- Correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) scores with legacy patient-reported outcome scores in patients undergoing rotator cuff repair.J Shoulder Elbow Surg. 2018; 27: S17-S23
- The impact of workers' compensation on patient-reported outcomes measurement information system upper extremity and legacy outcome measures in patients undergoing arthroscopic rotator cuff repair.Arthroscopy. 2019; 35: 2817-2824
- Preoperative performance of the patient-reported outcomes measurement information system in patients with rotator cuff pathology.Arthroscopy. 2017; 33 (e1771): 1770-1774
- Relationship between the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing and legacy instruments in patients undergoing isolated biceps tenodesis.J Shoulder Elbow Surg. 2020; 29: 1214-1222
- Performance of PROMIS global-10 compared with legacy instruments for rotator cuff disease.Am J Sports Med. 2019; 47: 181-188
- Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Versus Physical Function (PF) Computer Adaptive Tests (CATs) in upper extremity clinics.J Hand Surg Am. 2017; 42: 867-874
- Depression and pain interference correlate with physical function in patients recovering from hand surgery.Hand (N Y). 2019; 14: 830-835
- Measurement of upper extremity disability using the Patient-Reported Outcomes Measurement Information System.J Hand Surg Am. 2014; 39: 1160-1165
- Current concepts in orthopaedic care disparities.J Am Acad Orthop Surg. 2018; 26: 823-832
- Access to orthopaedic care.JBJS Rev. 2018; 6: e7
- Telemedicine: Is It a tool for orthopedics?.Curr Rev Musculoskelet Med. 2020; 13: 797-801
- Telemedicine in the era of COVID-19: The virtual orthopaedic examination.J Bone Joint Surg Am. 2020; 102: e57
- Effects of rotator cuff pathology and physical therapy on in vivo shoulder motion and clinical outcomes in patients with a symptomatic full-thickness rotator cuff tear.Orthop J Sports Med. 2016; 42325967116666506
- Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study.J Shoulder Elbow Surg. 2019; 28: 833-838
- Insurance status affects access to physical therapy following rotator cuff repair surgery: A comparison of privately insured and Medicaid patients.Orthop Rev (Pavia). 2019; 11: 7989
- Centers for Disease Control and Prevention Risk for COVID-19 Infection, Hospitalization, and Death by Race/Ethnicity.(Accessed November 28, 2022)
- Disparities in TKA outcomes: Census tract data show interactions between race and poverty.Clin Orthop Relat Res. 2016; 474: 1986-1995
- Does race affect outcomes in total joint arthroplasty?.Clin Orthop Relat Res. 2015; 473: 3535-3541
- Impact of gender and race on expectations and outcomes in total knee arthroplasty.World J Orthop. 2020; 11: 265-277
- Disparities in total hip arthroplasty outcomes: Census tract data show interactions between race and community deprivation.J Am Acad Orthop Surg. 2018; 26: e457-e464
- Racial disparities in peri-operative complications following primary total hip arthroplasty.J Orthop. 2020; 21: 155-160
- Racial disparities in lower extremity arthroplasty outcomes and use.Orthopedics. 2015; 38: e1139-1146
- The association of race/ethnicity and total knee arthroplasty outcomes in a universally insured population.J Arthroplasty. 2020; 35: 1474-1479
- Racial disparities in outcomes of operatively treated lower extremity fractures.Arch Orthop Trauma Surg. 2017; 137: 1335-1340
- Complications and revision amputation following trauma-related lower limb loss.Injury. 2017; 48: 364-370
- The association between race/ethnicity and outcomes following primary shoulder arthroplasty.J Shoulder Elbow Surg. 2020; 29: 886-892
- The effect of race on early perioperative outcomes after shoulder arthroplasty: A propensity score matched analysis.Orthopedics. 2019; 42: 95-102
- Outcomes following surgical management of cauda equina syndrome: Does race matter?.J Racial Ethn Health Disparities. 2018; 5: 287-292
- Racial disparities in surgical outcomes after spine surgery: An ACS-NSQIP analysis.Global Spine J. 2019; 9: 583-590
- The influence of race on short-term outcomes after laminectomy and/or fusion spine surgery.Spine (Phila Pa 1976). 2017; 42: 34-41
- Neighborhood socioeconomic status affects patient-reported outcome 2 years after ACL reconstruction.Orthop J Sports Med. 2019; 72325967119851073
- The effect of lower socioeconomic status insurance on outcomes after primary shoulder arthroplasty.J Shoulder Elbow Surg. 2018; 27: S35-s42
- Socioeconomic status impacts outcomes following pediatric anterior cruciate ligament reconstruction.Medicine (Baltimore). 2019; 98e15361
- Socioeconomic status is associated with risk of above-knee amputation after periprosthetic joint infection of the knee.Clin Orthop Relat Res. 2019; 477: 1531-1536
- Socioeconomic status, insurance status, and outcomes in spinal surgery.Spine (Phila Pa 1976). 2020; 45: E974
- Sex-based differences in patient-reported outcomes after arthroscopic rotator cuff repair.Orthop J Sports Med. 2019; 72325967119881959
- Male and female differences in musculoskeletal disease.J Am Acad Orthop Surg. 2015; 23: 339-347
- The musculoskeletal effects of perioperative smoking.J Am Acad Orthop Surg. 2012; 20: 359-363
- Disparities in access to musculoskeletal care: Narrowing the gap: AOA Critical Issues Symposium.J Bone Joint Surg Am. 2019; 101: e121
- Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: A time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program.Am J Sports Med. 2012; 40: 359-366
- Telemedicine in hand and upper-extremity surgery.J Hand Surg Am. 2020; 45: 239-242
- Median household income and mortality rate in cystic fibrosis.Pediatrics. 2003; 111: e333-339
Article info
Publication history
Published online: October 05, 2022
Accepted:
August 29,
2022
Received:
May 12,
2021
Footnotes
See commentary on page 243
The authors report the following potential conflicts of interest or sources of funding: E.C.M. reports personal fees from Smith & Nephew, Springer, and Xodus Medical; J.P.C. reports membership of Editorial Board of Arthroscopy Stock/ownership (Protera Health), Editorial Board (Arthroscopy), Board/Committee (American Academy of Orthopaedic Surgeons) and other from the American Orthopaedic Society for Sports Medicine (AOSSM), outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
