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Bonsel JM, Reijman M, Verhaar JAN, van Steenbergen LN, Janssen MF, Bonsel GJ. Socioeconomic inequalities in patient-reported outcome measures of Dutch primary hip and knee arthroplasty patients for osteoarthritis. Osteoarthritis Cartilage 2024; 32:200-209. [PMID: 37482250 DOI: 10.1016/j.joca.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To study socio-economic inequalities in patient-reported outcomes in primary hip and knee arthroplasty (THA/TKA) patients for osteoarthritis, using two analytical techniques. METHODS We obtained data from 44,732 THA and 30,756 TKA patients with preoperative and 12-month follow-up PROMs between 2014 and 2020 from the Dutch Arthroplasty Registry. A deprivation indicator based on neighborhood income, unemployment rate, and education level was linked and categorized into quintiles. The primary outcome measures were the EQ-5D-3L index and Oxford Hip/Knee Score (OHS/OKS) preoperative, at 12-month follow-up, and the calculated change score between these measurements. We contrasted the most and least deprived quintiles using multivariable linear regression, adjusting for patient characteristics. Concurrently, we calculated concentration indices as a non-arbitrary tool to quantify inequalities. RESULTS Compared to the least deprived, the most deprived THA patients had poorer preoperative (EQ-5D -0.03 (95%CI -0.02, -0.04), OHS -1.26 (-0.99, -1.52)) and 12-month follow-up health (EQ-5D -0.02 (-0.01, -0.02), OHS -0.42 (-0.19, -0.65)), yet higher mean change (EQ-5D 0.02 (0.01, 0.03), OHS 0.84 (0.52, 1.16)). The most deprived TKA patients had similar results. The higher mean change among the deprived resulted from lower preoperative health in this group (confounding). After accounting for this, the most deprived patients had a lower mean change. The concentration indices showed similar inequality effects and provided information on the magnitude of inequalities over the entire socio-economic range. CONCLUSION The most deprived THA and TKA patients have worse preoperative health, which persisted after surgery. The concentration indices allow comparison of inequalities across different outcomes (e.g., revision risk).
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Affiliation(s)
- Joshua M Bonsel
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, the Netherlands.
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), the Netherlands.
| | - Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, the Netherlands.
| | - Gouke J Bonsel
- EuroQol Research Foundation, Rotterdam, the Netherlands.
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2
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Schatz C, Plötz W, Beckmann J, Bredow K, Leidl R, Buschner P. Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2023; 143:6741-6751. [PMID: 37306776 PMCID: PMC10258736 DOI: 10.1007/s00402-023-04929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Total knee arthroplasty are among the most frequently conducted surgeries, due to an aging society. Since hospital costs are subsequently rising, adequate preparation of patients and reimbursement becomes more and more important. Recent literature revealed anemia as a risk factor for enhanced length of stay (LOS) and complications. This study analyzed whether preoperative hemoglobin (Hb) and postoperative Hb were associated with total hospital costs and general ward costs. METHODS The study comprised 367 patients from a single high-volume hospital in Germany. Hospital costs were calculated with standardized cost accounting methods. Generalized linear models were applied to account for confounders, such as age, comorbidities, body mass index, insurance status, health-related quality of life, implant types, incision-suture-time and tranexamic acid. RESULTS Preoperative anemic women had 426 Euros higher general ward costs (p < 0.01), due to increased LOS. For men, 1 g/dl less Hb loss between the preoperative value and the value before discharge reduced total costs by 292 Euros (p < 0.001) and 161 Euros fewer general ward costs (p < 0.001). Total hospital costs were reduced by 144 Euros with 1 g/dl higher Hb on day 2 postoperatively for women (p < 0.01). CONCLUSION Preoperative anemia was associated with increased general ward costs for women and Hb loss with decreasing total hospital costs for men and women. Cost containment, especially reduced utilization of the general ward, may be feasible with the correction of anemia for women. Postoperative Hb values may be a factor for adjustments of reimbursement systems. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany.
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany.
- Environmental Health Center at Helmholtz Munich, Munich, Germany.
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Orthopaedic Praxis Munich-Nymphenburg, Munich, Germany
| | - Johannes Beckmann
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Katharina Bredow
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Reiner Leidl
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Rojewski S, Westberg M, Nordsletten L, Meyer HE, Holvik K, Furnes O, Fenstad AM, Dahl J. Postvaccination immune responses and risk of primary total hip arthroplasty-A population-based cohort study. Osteoarthritis Cartilage 2023; 31:1249-1256. [PMID: 37236299 DOI: 10.1016/j.joca.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/23/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the relationship between individual postvaccination immune responses and subsequent risk of total hip arthroplasty (THA) due to idiopathic osteoarthritis (OA) or rheumatoid arthritis (RA). METHOD Results of tuberculin skin tests (TSTs) following the Bacille Calmette-Guerin (BCG) vaccination were used as a marker of individual immune responses. TST results from the mandatory mass tuberculosis screening program 1948-1975 (n = 236 770) were linked with information on subsequent THA during 1987-2020 from the Norwegian Arthroplasty Register. The multivariable Cox proportional hazard regression was performed. RESULTS A total of 10 698 individuals received a THA during follow-up. In men, there was no association between TST and risk of THA due to OA (Hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.92-1.12 for positive versus negative TST and HR 1.06, 95% CI 0.95-1.18 for strong positive vs negative TST), while the risk estimates increased with increasingly restrictive sensitivity analyses. In women, there was no association with THA due to OA for positive versus negative TST (HR 0.98, 95% CI 0.92-1.05), while a strong positive TST was associated with reduced risk of THA (HR 0.90, 95% CI 0.84-0.97). No significant associations were observed in the sensitivity analysis for women or for THA due to RA. CONCLUSION Our results suggest that an increased postvaccination immune response is associated with a nonsignificant trend of increased risk of THA among men and a decreased risk among women, although risk estimates were small.
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Affiliation(s)
- Sonia Rojewski
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
| | - Marianne Westberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway.
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Jesper Dahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
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4
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Karimi A, Burkhart RJ, Hecht CJ, Acuña AJ, Kamath AF. Is Social Deprivation Associated With Usage, Adverse Events, and Patient-reported Outcome Measures in Total Joint Arthroplasty? A Systematic Review. Clin Orthop Relat Res 2023; 481:239-250. [PMID: 36103392 PMCID: PMC9831197 DOI: 10.1097/corr.0000000000002394] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To capture various social determinants of health, recent analyses have used comprehensive measures of socioeconomic disadvantage such as deprivation and vulnerability indices. Given that studies evaluating the effects of social deprivation on total joint arthroplasty (TJA) have yielded mixed results, a systematic review of this relationship might help answer questions about usage, complications, and results after surgery among patients in different socioeconomic groups and help guide targeted approaches to ensure health equity. QUESTIONS/PURPOSES We asked: How is social deprivation associated with TJA (1) usage, (2) adverse events including discharge deposition and length of stay, and (3) patient-reported outcome measures (PROMs)? METHODS A comprehensive review of the PubMed, EBSCO host, Medline, and Google Scholar electronic databases was conducted to identify all studies that evaluated social deprivation and TJA between January 1, 2000, and March 1, 2022. Studies were included if they evaluated comprehensive measures of socioeconomic deprivation rather than individual social determinants of health. Nineteen articles were included in our final analysis with a total of 757,522 patients. In addition to characteristics of included studies (such as patient population, procedure evaluated, and utilized social deprivation metric), we recorded TJA usage, adverse events, and PROM values as reported by each article. Two reviewers independently evaluated the quality of included studies using the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean ± SD MINORS score was 13 ± 1 of 16, with higher scores representing better study quality. All the articles included are noncomparative studies. Given the heterogeneity of the included studies, a meta-analysis was not performed and results were instead presented descriptively. RESULTS Although there were inconsistencies among the included articles, higher levels of social deprivation were associated with lower TJA usage even after controlling for various confounding variables. Similarly, there was agreement among studies regarding higher proportion of nonhome discharge for patients with more social deprivation. Although there was limited agreement across studies regarding whether patients with more social deprivation had differences in their baseline and postoperative PROMs scores, patients with more social deprivation had lower improvements from baseline for most of the included articles. CONCLUSION These findings encourage continued efforts focusing on appropriate patient education regarding expectations related to functional improvement and the postoperative recovery process, as well as resources available for further information and social support. We suggest linking patient data to deprivation measures such as the Area Deprivation Index to help encourage shared decision-making strategies that focus on health literacy and common barriers related to access. Given the potential influence social deprivation may have on the outcome and utilization of TJA, hospitals should identify methods to determine patients who are more socially deprived and provide targeted interventions to help patients overcome any social deprivation they are facing. We encourage physicians to maintain close communication with patients whose circumstances include more severe levels of social deprivation to ensure they have access to the appropriate resources. Additionally, as multiple social deprivation metrics are being used in research, future studies should identify a consistent metric to ensure all patients that are socially deprived are reliably identified to receive appropriate treatment. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Amir Karimi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J. Burkhart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christian J. Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alexander J. Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Witkam R, Verstappen SMM, Gwinnutt JM, Cook MJ, O'Neill TW, Cooper R, Humphreys J. The association between lower socioeconomic position and functional limitations is partially mediated by obesity in older adults with symptomatic knee osteoarthritis: Findings from the English Longitudinal Study of Ageing. Front Public Health 2022; 10:1053304. [PMID: 36600944 PMCID: PMC9806847 DOI: 10.3389/fpubh.2022.1053304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To assess the longitudinal associations of socioeconomic position (SEP) with functional limitations and knee joint replacement surgery (JRS) in people with symptomatic knee osteoarthritis (OA), and whether body mass index (BMI) mediated these relationships. Methods Data came from the English Longitudinal Study of Ageing, a national longitudinal panel study of adults aged ≥50 years. A total of 1,499 participants (62.3% female; mean age 66.5 (standard deviation (SD) 9.4) years; 47.4% obese) self-reporting an OA diagnosis and knee pain, with at least one BMI measurement were included. Mixed effect models estimated longitudinal associations of each SEP variable (education, occupation, income, wealth and deprivation index) and obesity (BMI ≥30.0 kg/m2) with repeated measures of functional limitations. Cox regression analyses estimated associations between SEP indicators and obesity at baseline and risk of knee JRS at follow-up. Structural equation modeling estimated any mediating effects of BMI on these relationships. Results Lower SEP and obesity at baseline were associated with increased odds of functional limitations in people with knee OA [e.g., difficulty walking 100 yards: no qualification vs. degree adjOR 4.33 (95% CI 2.20, 8.55) and obesity vs. no obesity adjOR 3.06 (95% CI 2.14, 4.37); similar associations were found for the other SEP indicators]. A small proportion of the association between lower SEP and functional limitations could be explained by BMI (6.2-12.5%). Those with lower income, lower wealth and higher deprivation were less likely to have knee JRS [e.g., adjHR most vs. least deprived 0.37 (95% CI 0.19, 0.73)]; however, no clear association was found for education and occupation. Obesity was associated with increased hazards of having knee JRS [adjHR 1.87 (95% CI 1.32, 2.66)]. As the direction of the associations for SEP and obesity with knee JRS were in opposite directions, no mediation analyses were performed. Conclusions Lower SEP was associated with increased odds of functional limitations but lower hazards of knee JRS among people with knee OA, potentially indicating underutilization of JRS in those with lower SEP. Obesity partially mediated the relationship between lower SEP and increased odds of functional limitations, suggesting adiposity as a potential interventional target.
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Affiliation(s)
- Rozemarijn Witkam
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Suzanne M. M. Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom,*Correspondence: Suzanne M. M. Verstappen
| | - James M. Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Michael J. Cook
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Terence W. O'Neill
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom,AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jennifer Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Stankovic N, Holmberg MJ, Granfeldt A, Andersen LW. Socioeconomic status and outcomes after in-hospital cardiac arrest. Resuscitation 2022; 180:140-149. [PMID: 36029912 DOI: 10.1016/j.resuscitation.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023]
Abstract
AIM To investigate the association between socioeconomic status and outcomes after in-hospital cardiac arrest in Denmark. METHODS We conducted an observational cohort study based on nationwide registries and prospectively collected data on in-hospital cardiac arrest from 2017 and 2018 in Denmark. Unadjusted and adjusted analyses using regression models were performed to assess the association between socioeconomic status and outcomes after in-hospital cardiac arrest. Outcomes included return of spontaneous circulation (ROSC), survival to 30 days, survival to one year, and the duration of resuscitation among patients without ROSC. RESULTS A total of 3,223 patients with in-hospital cardiac arrest were included in the study. In the adjusted analyses, high household assets were associated with 1.20 (95 %CI: 0.96, 1.51) times the odds of ROSC, 1.49 (95 %CI: 1.14, 1.96) times the odds of survival to 30 days, 1.40 (95 %CI: 1.04, 1.90) times the odds of survival to one year, and 2.8 (95 %CI: 0.9, 4.7) minutes longer duration of resuscitation among patients without ROSC compared to low household assets. Similar albeit attenuated associations were observed for education. While high household income was associated with better outcomes in the unadjusted analyses, these associations largely disappeared in the adjusted analyses. CONCLUSIONS In this study of patients with in-hospital cardiac arrest, we found that high household assets were associated with a higher odds of survival and a longer duration of resuscitation among patients without ROSC compared to low household assets. However, the effect size may potentially be small. The results varied based on socioeconomic status measure, outcome of interest, and across adjusted analyses.
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Affiliation(s)
- Nikola Stankovic
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mathias J Holmberg
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark
| | - Asger Granfeldt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Lars W Andersen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Denmark.
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Zaballa E, Ntani G, Harris EC, Lübbeke A, Arden NK, Hannouche D, Cooper C, Walker-Bone K. Feasibility and sustainability of working in different types of jobs after total hip arthroplasty: analysis of longitudinal data from two cohorts. Occup Environ Med 2022; 79:486-493. [PMID: 35027440 DOI: 10.1136/oemed-2021-107970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the rates of return to work and workability among working-age people following total hip arthroplasty (THA). METHODS Participants from the Geneva Arthroplasty Registry and the Clinical Outcomes for Arthroplasty Study aged 18-64 years when they had primary THA and with at least 5 years' follow-up were mailed a questionnaire 2017-2019. Information was collected about preoperative and post-THA employment along with exposure to physically demanding activities at work or in leisure. Patterns of change of job were explored. Survival analyses using Cox proportional hazard models were created to explore risk factors for having to stop work because of difficulties with the replaced hip. RESULTS In total, 825 returned a questionnaire (response 58%), 392 (48%) men, mean age 58 years, median follow-up 7.5 years post-THA. The majority (93%) of those who worked preoperatively returned to work, mostly in the same sector but higher rates of non-return (36%-41%) were seen among process, plant and machine operatives and workers in elementary occupations. 7% reported subsequently leaving work because of their replaced hip and the risk of this was strongly associated with: standing >4 hours/day (HR 3.81, 95% CI 1.62 to 8.96); kneeling/squatting (HR 3.32, 95% CI 1.46 to 7.55) and/or carrying/lifting ≥10 kg (HR 5.43, 95% CI 2.29 to 12.88). CONCLUSIONS It may be more difficult to return to some (particularly physically demanding) jobs post-THA than others. Rehabilitation may need to be targeted to these types of workers or it may be that redeployment or job change counselling are required.
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Affiliation(s)
- Elena Zaballa
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - E Clare Harris
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Didier Hannouche
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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8
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Delanois RE, Sax OC, Wilkie WA, Douglas SJ, Mohamed NS, Mont MA. Social Determinants of Health in Total Hip Arthroplasty: Are They Associated With Costs, Lengths of Stay, and Patient Reported Outcomes? J Arthroplasty 2022; 37:S422-S427. [PMID: 35272898 DOI: 10.1016/j.arth.2022.02.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Social determinants of health (SDOH) may play a larger role in predicting patient outcomes as outpatient total hip arthroplasty (THA) expands. We specifically examined the association between SDOH and patient metrics (demographics and comorbidities) for: (1) 30-day post-discharge costs of care; (2) lengths of stay (LOS); and (3) patient-reported outcomes (Hip Disability and Osteoarthritis Outcomes Score for Joints Replacement (HOOS JR)). METHODS Medicare patients who underwent primary THA between 2018 and 2019 were identified. Those who had complete social determinant data were included (n = 136). Data elements were drawn from institutional, regional, and government databases, as well as the Social Vulnerability Index (SVI). Multiple regression analyses were performed to determine SDOH and baseline comorbidities associations with costs, LOS, and HOOS JR scores. RESULTS Various SDOH factors were associated with higher 30-day costs, including residing in a food desert ($53,695 ± 15,485; P < .001) and the following SVI themes: 'Minority Status and Language' ($24,075 ± 9845; P = .01) and 'Housing and Transportation' ($16,190 ± 8501; P = .06), although the latter did not meet statistical significance. Baseline depression was associated with longer LOS (P = .02), while none of the other SDOH or patient metrics affected LOS. No relationships were observed between SDOH and HOOS JR changes from baseline. CONCLUSION Patients who live in food deserts and have minority status had higher costs of care after primary THA. Poor housing and transportation may also increase costs, albeit insignificantly. These results highlight the utility of assessing SDOH-related risk factors to optimize post-operative outcomes, with potential implications for bundled care.
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Affiliation(s)
- Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Wayne A Wilkie
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Scott J Douglas
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Nequesha S Mohamed
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
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9
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Khlopas A, Grits D, Sax OC, Chen Z, Orr MN, Klika AK, Mont MA, Piuzzi NS. Neighborhood Socioeconomic Disadvantages Associated With Prolonged Lengths of Stay, Nonhome Discharges, and 90-Day Readmissions After Total Knee Arthroplasty. J Arthroplasty 2022; 37:S37-S43.e1. [PMID: 35221134 DOI: 10.1016/j.arth.2022.01.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/17/2021] [Accepted: 01/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Low socioeconomic status and neighborhood context has been linked to poor health care outcomes after total knee arthroplasty (TKA). The area deprivation index (ADI) addresses this relationship by ranking neighborhoods by socioeconomic disadvantage. We examined the following relationships of the ADI among TKA recipients: (1) patient demographics, (2) lengths of stay (LOS), (3) nonhome discharges, and (4) 90-day readmissions, emergency department visits, and reoperations. METHODS We reviewed a consecutive series of primary TKAs from 2018 through 2020 at a tertiary health care system. A total of 3928 patients who had complete ADI data were included. A plurality of patients (14.9%) were categorized within ADI 31-40, below the national median ADI of 47. Associations between the national ADI decile and 90-day postoperative health care utilization metrics were evaluated using multivariate regressions (adjusted for patient demographics and comorbidities). RESULTS The 91-100 ADI cohort was disproportionately African American, female, younger, and smokers. Compared with ADI 31-40 (reference), the ADI 61-70 cohort was associated with higher odds of LOS ≥3 days (odds ratio [OR] = 1.6 [1.08-2.36], P = .019) and nonhome discharges (OR = 1.73 [1.08-2.75], P = .021). The ADI 91-100 cohort was associated with the highest odds of prolonged LOS (OR = 2.27; [1.47-3.49], P < .001), nonhome discharges (OR = 3.49 [2.11-5.78], P < .001), and all-cause readmissions (OR: 1.79, [1.02-3.14], P = .044). No significant associations were found between the ADI and 90-day emergency department visits or reoperations (P > .05). CONCLUSION A higher ADI was associated with prolonged LOS, nonhome discharge status, and 90-day readmissions after TKA. This index highlights potential areas of intervention for assessing health care outcomes.
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Affiliation(s)
- Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Melissa N Orr
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
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STISEN MB, KLENØ AN, JACOBSEN JS, O’CONNELL MDL, AYIS S, SACKLEY C, PEDERSEN AB, MECHLENBURG I. Do changes in outcomes following primary and revision hip replacement differ and relate to markers of socioeconomic status? A 1-year population-based cohort study. Acta Orthop 2022; 93:397-404. [PMID: 35383857 PMCID: PMC8985216 DOI: 10.2340/17453674.2022.2430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE There is little evidence on improvement after revision total hip replacement (THR). Moreover, improvements may be associated with socioeconomic status (SES). We investigated whether changes in Harris Hip Score (HHS) differ among patients undergoing primary and revision THR, and their association with markers of SES. PATIENTS AND METHODS We conducted a populationbased cohort study on 16,932 patients undergoing primary and/or revision THR from 1995 to 2018 due to hip osteoarthritis. The patients were identified in the Danish Hip Arthroplasty Registry. Outcome was defined as mean change in HHS (0-100) from baseline to 1-year follow-up, and its association with SES markers (education, cohabiting, and wealth) was analyzed using multiple linear regression adjusting for sex, age, comorbidities, and baseline HHS. RESULTS At 1-year follow-up, HHS improved clinically relevant for patients undergoing both primary THR: mean 43 (95% CI 43-43) and revision THR: mean 31 (CI 29-33); however, the increase was 12 points (CI 10-14) higher for primary THR. For primary THR, improvements were 0.9 points (CI 0.4-1.5) higher for patients with high educational level compared with low educational level, 0.4 points (CI 0.0-0.8) higher for patients cohabiting compared with living alone, and 2.6 points higher (CI 2.1-3.0) for patients with high wealth compared with low wealth. INTERPRETATION Patients undergoing primary THR achieve higher improvements on HHS than patients undergoing revision THR, and the improvements are negatively related to markers of low SES. Health professionals should be aware of these characteristics and be able to identify patients who may benefit from extra rehabilitation to improve outcomes after THR to ensure equality in health.
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Affiliation(s)
- Martin B STISEN
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - André N KLENØ
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Julie S JACOBSEN
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark,Research Unit for General Practice in Aarhus, Aarhus, Denmark
| | - Matthew D L O’CONNELL
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Salma AYIS
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Catherine SACKLEY
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Alma B PEDERSEN
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inger MECHLENBURG
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Frydenlund J, Mackenhauer J, Christensen EF, Christensen HC, Væggemose U, Steinmetz J, Johnsen SP. Socioeconomic Disparities in Prehospital Emergency Care in a Danish Tax-Financed Healthcare System: Nationwide Cohort Study. Clin Epidemiol 2022; 14:555-565. [PMID: 35509522 PMCID: PMC9058017 DOI: 10.2147/clep.s358801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Differences related to socioeconomic status (SES) in use of prehospital emergency medical services (EMS) have been reported. However, detailed data on potential disparities in the quality of the EMS according to SES are lacking. Methods A nationwide cohort study of medical emergency calls made to the Danish emergency number 1-1-2 in the period 2016–2017. To measure quality of care, performance indicators from the Danish Quality Registry for Prehospital Emergency Medical Services were used. SES was based on income, education and adherence to workforce. Poisson regression was used to measure relative risk (RR). Results We included 388,378 medical 1-1-2 calls, of which 261,771 were unique individuals; 42% of the calls concerned patients with low education, 5% concerned patients living in relative poverty and 23% concerned patients receiving social subsidy. There were no significant differences between the SES regarding time span for arrival of first EMS units. However, patients receiving social subsidy and retired people were more likely to be released at scene and to call again within 24 hours: Adjusted RRs were 2.79 [2.20; 3.54] and 2.08 [1.58; 2.75], respectively, compared with patients having a job. In addition, patients receiving social subsidy and retired people were more likely to call again within 24 hours after receiving telephone advice only: Adjusted RRs 2.35 [1.95; 2.82] and 1.88 [1.51; 2.35], respectively compared with patients having a job. Adjusted RRs for unplanned hospital contact after being treated and released at scene were higher for patients receiving social subsidy and retired people, respectively, relative to patients having a job. Conclusion Patients with low SES were significantly more likely to contact the hospital or EMS again after their first call or after treatment and release at scene compared with patients with high SES. This indicates that callers with low SES did not receive the appropriate help.
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Affiliation(s)
- Juliane Frydenlund
- Department of Clinical Medicine, Aalborg University, Aalborg East, 9220, Denmark
- Correspondence: Juliane Frydenlund, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, Aalborg East, 9220, Denmark, Tel +45 24671465, Email
| | - Julie Mackenhauer
- Department of Clinical Medicine, Aalborg University, Aalborg East, 9220, Denmark
| | - Erika F Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
- Clinic for Internal and Emergency Medicine, Aalborg University Hospital, Aalborg, 9000, Denmark
- Emergency Medical Services, North Denmark Region, Aalborg, 9000, Denmark
| | | | - Ulla Væggemose
- Department of Research & Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jacob Steinmetz
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
- Danish Air Ambulance, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Aalborg University, Aalborg East, 9220, Denmark
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12
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Lian Q, Wang J, Lian Y, Yang Q, Zhao M, Zhang Y. Impact of valvular heart disease on hip replacement: a retrospective nationwide inpatient sample database study. BMC Musculoskelet Disord 2021; 22:860. [PMID: 34627205 PMCID: PMC8501620 DOI: 10.1186/s12891-021-04738-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty. METHODS This was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time. RESULTS VHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12-1.18]), elective admission (OR = 0.78 [0.76-0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03-1.08]), large-volume hospitals (OR = 1.13 [1.1-1.2]), teaching hospitals (OR = 5 4.4 [2.9-6.7]), and hospital location in urban areas (OR = 1.22 [1.2-1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87-3.04]), acute pulmonary edema (OR = 1.13 [1.06-1.21]), acute cerebrovascular event (OR = 1.22 [1.16-1.74]), and acute renal failure (OR = 1.22 [1.17-1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8-0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27-4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32-2.8]) and elective admission (OR = 0.51 [0.36-0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76-3.53]) and acute hepatic failure (OR = 7.69 [1.8-32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost. CONCLUSION VHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.
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Affiliation(s)
- Qiang Lian
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Yun Lian
- First Affiliation Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Mingchen Zhao
- Goodwill Hessian Health Technology Co., Ltd., Beijing, 100007, China
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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13
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Edwards NM, Varnum C, Overgaard S, Pedersen AB. Impact of socioeconomic status on the 90- and 365-day rate of revision and mortality after primary total hip arthroplasty: a cohort study based on 103,901 patients with osteoarthritis from national databases in Denmark. Acta Orthop 2021; 92:581-588. [PMID: 34085592 PMCID: PMC8519516 DOI: 10.1080/17453674.2021.1935487] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Socioeconomic inequality in health is recognized as an important public health issue. We examined whether socioeconomic status (SES) is associated with revision and mortality rates after total hip arthroplasty (THA) within 90 and 365 days.Patients and methods - We obtained SES markers (cohabitation, education, income, and liquid assets) on 103,901 THA patients from Danish health registers (year 1995-2017). The outcomes were any revision (all revisions), specified revision (due to infection, fracture, or dislocation), and mortality. We used Cox regression analysis to estimate adjusted hazard ratio (aHR) of each outcome with 95% confidence interval (CI) for each SES marker.Results - Within 90 days, the aHR for any revision was 1.3 (95% CI 1.1-1.4) for patients living alone vs. cohabiting. The aHR was 2.0 (CI 1.4-2.6) for low-income vs. high-income among patients < 65 years. The aHR was 1.2 (CI 0.9-1.7) for low liquid assets among patients > 65 years. Results were consistent for any revision within 365 days as well as for revisions due to infection, fracture, and dislocation. The aHR for mortality was 1.4 (CI 1.2-1.6) within 90 days and 1.3 (CI 1.2-1.5) within 365 days for patients living alone vs. cohabiting. Low education, low income, and low liquid assets were associated with increased mortality rate within both 90 and 365 days.Interpretation - Our results suggest that living alone, low income, and low liquid assets were associated with increased revision and mortality up to 365 days after THA surgery. Optimizing medical conditions prior to surgery and implementing different post-THA support strategies with a focus on vulnerable patients may reduce complications associated with inequality.
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Affiliation(s)
- Nina M Edwards
- Department of Clinical Epidemiology, Aarhus University Hospital,Correspondence: Nina M EDWARDS, Department of Clinical Epidemiology, Aarhus University Hospital,
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital—Vejle, and Department of Regional Health Research, University of SouthernDenmark,Danish Hip Arthroplasty Register
| | - Søren Overgaard
- Danish Hip Arthroplasty Register,Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, University of Copenhagen; and Department of Clinical Medicine, Faculty of Health and Medical Sciences, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital
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