Neighborhood Socioeconomic Disadvantage is Associated With Increased Health Care Utilization After Septic and Aseptic Revision Total Hip Arthroplasty

Benjamin E Jevnikar; Nickelas Huffman; Ignacio Pasqualini; Chao Zhang; Alison K Klika; Matthew E Deren; CCARR Corporate Authorship; Nicolas S Piuzzi

doi:10.1016/j.arth.2024.09.014

Neighborhood Socioeconomic Disadvantage is Associated With Increased Health Care Utilization After Septic and Aseptic Revision Total Hip Arthroplasty

J Arthroplasty. 2024 Sep 16:S0883-5403(24)00951-3. doi: 10.1016/j.arth.2024.09.014. Online ahead of print.

Authors

Benjamin E Jevnikar¹, Nickelas Huffman¹, Ignacio Pasqualini¹, Chao Zhang¹, Alison K Klika¹, Matthew E Deren¹; CCARR Corporate Authorship; Nicolas S Piuzzi²

Collaborators

CCARR Corporate Authorship:
Ethan Ruhland, Josh L Tidd, Lakshmi S Gudapati, Robert M Molloy, Trevor G Murray, Viktor E Krebs, Peter Surace, John P McLaughlin, Michael R Bloomfield, Shujaa T Khan

Affiliations

¹ Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.
² Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio.

PMID: 39293696
DOI: 10.1016/j.arth.2024.09.014

Abstract

Background: A greater area deprivation index (ADI), a tool that gauges socioeconomic disadvantage at the neighborhood level, is associated with worse health care outcomes following primary total hip arthroplasty. However, its association with revision total hip arthroplasty (rTHA) is unknown. This study aimed to determine the association between ADI and rates of postoperative health care resource utilization following rTHA.

Methods: A total of 996 patients who underwent rTHA between 2016 and 2022 were enrolled in a prospective study. The primary outcomes assessed were nonhome discharge disposition (DD), length of stay (LOS) ≥ three days, 90-day emergency department (ED) visits, and 90-day hospital readmissions. The ADI was calculated using the patient's home address at the time of surgery, with greater ADI indicating greater socioeconomic disadvantage. We evaluated the mediation effect of patient race on ADI and postoperative health care utilization using a multivariable logistic regression model.

Results: A higher median ADI was revealed for patients who experienced nonhome discharge (P = 0.001), extended LOS (P < 0.001), and ED readmission within 90 days of surgery (P = 0.045). When comparing septic versus aseptic rTHA patients, there were significant differences in health care resource utilization but no difference in ADI between the two groups. For aseptic rTHA, ADI significantly mediated the effect of race on both nonhome DD and LOS ≥ 3 (41 and 46% mediation, respectively). In septic rTHA, ADI mediated 31.1% of the effect of race on nonhome DD, but showed minimal mediation effect on LOS. The mediation effect of ADI on ED admission and hospital readmission was minimal for both groups.

Conclusions: Higher ADI scores are associated with increased health care utilization after rTHA, including longer hospital stays and more nonhome discharges. The ADI significantly mediates the effect of race on these outcomes, particularly in aseptic rTHA cases, suggesting that neighborhood socioeconomic factors play a crucial role in previously observed racial disparities.

Keywords: area deprivation index; discharge disposition; length of stay; readmission; revision total hip arthroplasty.