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Social Determinants of Health Disparities are Associated with Increased Costs, Revisions, and Infection in Patients Undergoing Arthroscopic Rotator Cuff Repair

Published:October 27, 2022DOI:https://doi.org/10.1016/j.arthro.2022.10.011

      ABSTRACT

      Purpose

      The purpose of this study was to use a national claims database to assess the impact of preexisting social determinants of health disparities (SDHD) on postoperative outcomes following RCR.

      Methods

      A retrospective review of the Mariner Claims Database was used to capture patients undergoing primary RCR with at least one year of follow-up. These patients were divided into two cohorts based on the presence of a current or previous history of SDHD, encompassing educational, environmental, social, or economic disparities. Records were queried for 90-day postoperative complications, consisting of minor and major medical complications, emergency department (ED) visits, readmission, stiffness, and one-year ipsilateral revision surgery. Multivariate logistic regression was employed to assess the impact of SDHD on the assessed postoperative outcomes following RCR.

      Results

      58,748 patients undergoing primary RCR with a SDHD diagnosis and 58,748 patients in the matched control group were included. A previous diagnosis of SDHD was associated with an increased risk of ED visits (OR 1.22, 95% CI 1.18-1.27, p<0.001), postoperative stiffness (OR 2.53, 95% CI 2.42-2.64, p<0.001), and revision surgery (OR 2.35, 95% CI 2.13-2.59, p<0.001) compared to the matched control group. Subgroup analysis revealed educational disparities had the greatest risk for one year revision (OR 3.13, 95% CI 2.53-4.05, p<0.001).

      Conclusions

      Presence of a SDHD was associated with an increased risk of revision surgery, postoperative stiffness, emergency room visits, medical complications, and surgical costs following arthroscopic RCR. Overall, economic, and educational SDHD were associated with the greatest risk of one year revision surgery.

      Keywords

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