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- BACKGROUND: The impact of social drivers of health (SDOH) on readmissions and costs after Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) is poorly understood. Policies such as the Hospital Readmissions Reduction Program (HRRP) have targeted overall readmission reduction, employing value-based strategies to improve healthcare quality. However, the implications of SDOH on these outcomes are not yet understood. We hypothesized that Area Deprivation Index (ADI) as a surrogate for SDOH would significantly influence readmission rates and healthcare costs in the 90-day post-procedural period for THA and TKA.
METHODS: We used the 100% US fee-for-service Medicare claims data from 2019 to 2021. Patients were identified using Diagnosis-Related Groups. Our primary outcomes included 90-day unplanned readmission following hospital discharge and cost of care, treated as “high cost” if >1 standard deviation above the mean. The relationships between ADI and primary outcomes were estimated with logistic regression models.
RESULTS: A total of 628,399 patients were included in this study. The mean age of patients was 75.6, 64% were female, and 7.8% were dually eligible for Medicaid. After full covariate adjustment, readmission was higher for patients in more deprived areas (high ADI) (Low SES Group OR: 1.30 [95% CI 1.23, 1.38]). ADI was not significantly associated with high cost after adjustment (Low SES Group OR 1.04 [95% CI 1.00, 1.07]).
CONCLUSION: This analysis highlights the impact of SDOH on readmission rates after THA and TKA. Beyond measures like HRRP, a nuanced understanding of neighborhood-level disparities will facilitate targeted strategies to reduce avoidable readmissions in orthopaedic surgery. Regarding cost, this study may illustrate that ADI for THA and TKA is not sufficiently granular to identify the contribution of social drivers to elevated costs. Screening for individual SDOH could provider further insights on drivers of cost in orthopaedic surgery.
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