The Impact of Social Deprivation on Healthcare Utilization Patterns Following Rotator Cuff Repair

Matthew Van Boxtel; Elizabeth Cinquegrani; Austin Middleton; Alexander Graf; Jessica Hanley; Anthony LoGiudice

doi:10.1016/j.jse.2024.01.038

The Impact of Social Deprivation on Healthcare Utilization Patterns Following Rotator Cuff Repair

J Shoulder Elbow Surg. 2024 Mar 27:S1058-2746(24)00156-3. doi: 10.1016/j.jse.2024.01.038. Online ahead of print.

Authors

Matthew Van Boxtel¹, Elizabeth Cinquegrani², Austin Middleton², Alexander Graf², Jessica Hanley², Anthony LoGiudice²

Affiliations

¹ Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226-0099, USA. Electronic address: mvanboxtel@mcw.edu.
² Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226-0099, USA.

PMID: 38552776
DOI: 10.1016/j.jse.2024.01.038

Abstract

Background: Disparities in social determinants of health have been linked to worse patient reported outcomes, higher pain, and increased risk of revision surgery following rotator cuff repair. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized.

Methods: This is a retrospective review of a single institution's experience with primary rotator cuff repair between 2012-2020. Demographic variables (age, race, gender, ASA score) and healthcare utilization (hospital readmission, emergency department visits, follow-up visits, telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index (ADI) was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared.

Results: A total of 1695 patients were included. The upper, middle, and lower terciles of ADI consisted of 410, 767, and 518 patients, respectively. The most deprived tercile had greater emergency department visitation and office visitation within 90 days of surgery relative to the least and intermediate deprived terciles. Higher levels of social deprivation were independent risk factors for increased ED visitation and follow-up visitation. There was no difference in 90-day readmission rates or telephone calls made between the least, intermediate, and most deprived patients.

Conclusions: Patients with higher levels of deprivation demonstrated greater postoperative hospital utilization. We hope to use these results to identify risk factors for increased hospital use, guide clinical decision making, increase transparency, and manage patient outcomes following rotator cuff repair surgery.

Keywords: Rotator cuff; deprivation; hospital readmission; shoulder; social determinants of health.