The impact of socioeconomic factors on 90-day postoperative readmissions and cost in shoulder arthroplasty patients

Background: Understanding the impact of Social Drivers of Health 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 postshoulder arthroplasty.

Methods: 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 codes. Our primary outcomes were 90-day unplanned readmissions and postprocedure 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.

Results: A total of 145,435 patients were included in our study. The average age of patients in our cohort was 74.5 year 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 < .001).When controlling for confounding factors, there was an independent association between high ADI and readmission (odds ratio {OR}: 1.28 [95% confidence interval {CI} 1.12, 1.46]). Overall, we saw a dose-dependent relationship between ADI and readmission, with the association growing stronger as ADI increased. Conversely, we found a negative association with ADI and high-costs. (High ADI group OR: 0.80 [95% CI 0.70, 0.91]). Patients in the high socioeconomic status (SES) group had higher health care contact days during the 90-day follow-up period, with a median of 16 visits (interquartile range [IQR] 8, 23), compared to 13 visits (IQR 6, 22) in the middle SES group and 10 visits (IQR 5, 20) in the low SES group (P < .001).

Conclusion: Socioeconomic disparities significantly influence the outcomes of primary shoulder arthroplasty, as indicated by higher readmission rates for low SES patients. Notably, our analysis shows a strong, independent association between ADI and readmission. Moreover, patients with higher SES incurred greater costs within a 90-day period potentially due to increased resource utilization.