Editorial Commentary: Smarter Than a Sixth Grader? Hip Arthroscopists, Check Your Training at the Door

Socioeconomic Factors Including Patient Income, Education Level, and Health Insurance Influence Postoperative Secondary Surgery and Hospitalization Rates Following Hip Arthroscopy

PURPOSE

To evaluate a large cross-sectional sample of patients utilizing administrative database records and analyze the effects of income, insurance type, and education level on outcomes after hip arthroscopy, including 2-year revision surgery, conversion to total hip arthroplasty (THA), and 90-day hospitalizations.

METHODS

Current Procedural Terminology codes were used to query the PearlDiver Mariner database from October 2015 to January 2020 for patients undergoing hip arthroscopy with a minimum 2-year follow-up. Patients were categorized by mean family income in their zip code of residence (MFIR), health insurance type, and educational attainment in their zip code of residence (EAR). Two-year revision arthroscopy, conversion to THA, and 90-day hospital readmissions or emergency department (ED) visits were analyzed along socioeconomic strata.

RESULTS

Multivariate analysis of 33,326 patients revealed that patients with MFIR between $30,000 and $70,000 had lower odds of 2-year revision arthroscopy (odds ratio [OR], 0.63; P < .001), THA conversion (OR, 0.76; P = .050), and 90-day readmission (OR, 0.53; P = .007) compared to MFIR >$100,000. Compared to patients with commercial insurance, patients with Medicare had lower odds of revision arthroscopy (OR, 0.60; P = .035) and THA conversion (OR, 0.46, P < .001) but greater odds of 90-day readmission (OR, 1.74; P = .007). Patients with Medicaid had higher odds of 90-day ED visits (OR, 1.84; P < .001). Patients with low EAR had higher odds of revision arthroscopy (OR, 1.42; P = .005) and THA conversion (OR, 1.58; P = .002) compared to those with high EAR.

CONCLUSIONS

Following hip arthroscopy, patients residing in areas with lower mean family income were less likely to undergo reoperations and readmissions. Medicare patients showed lower reoperation but higher readmission odds, while Medicaid patients showed higher odds of ED visits. Additionally, higher educational attainment in the zip code of residence is protective against future reoperation.

LEVEL OF EVIDENCE

Level III, retrospective case series.

Internet and Social Media Contribute to Medical Research Journal Growth

In 2010, our editorial team wrote about the Internet's inarguable role in overloading information on our readers. In this editorial, we reflect on insights gained, mostly in the past decade, regarding the Internet and social media. Medical and surgical information online is easy to obtain, but it varies from platform to platform, is low in quality and reliability, and overestimates the public's ability to decipher the information. Physicians do not use social media enough, or well. Social media can engage patients and can inform patients about the quality of medical and surgical information online. Physicians, themselves, can provide reliable information that informs patients and eases their minds. Physician-authors can use social media to develop communities with shared interests in research; members of these communities can post research findings and highlight the publications in which they find them. Discussion of research online increases the likelihood that it will be cited. It is no surprise that the Internet and social media have contributed to the growth of Arthroscopy; Arthroscopy Techniques; and Arthroscopy, Sports Medicine, and Rehabilitation.