Social determinants of health are independently predictive of increased hospital length of stay and complications following total elbow arthroplasty.

Abstract

Social determinants of health (SDOH) are the social, educational, environmental, and economic factors that affect health. The purpose of this study was to determine the effects of preoperative SDOH on the outcomes of total elbow arthroplasty (TEA). The Nationwide Readmissions Database was used to identify 316 patients with a SDOH diagnosis and 5426 controls who underwent primary TEA from 2016 to 2020. Primary outcomes included cost of admission and hospital length of stay (LOS), adverse clinical outcomes within 180 days and postoperative medical and surgical complications. Binary logistic regression identified independent predictors of postoperative complications. Multiple linear regression identified independent predictors of increased cost and hospital LOS. Compared to controls, patients with SDOH had higher odds of experiencing any complication (odds ratio [OR] 1.3; confidence interval [CI] 1.0-1.7), acute renal failure (OR 1.6; CI 1.0-2.4), cellulitis (OR 11; CI 5.1-23), surgical site infection (OR 2.7; CI 1.7-4.3), urinary tract infections (UTI) (OR 3.2; CI 2.2-4.6), and wound dehiscence (OR 5.7; CI 1.9-18). SDOH was shown to be independently predictive of postoperative cellulitis (OR 7.2; CI 2.9-18) and UTI (OR 2.0; CI 1.3-3.1). SDOH was correlated with increased hospital LOS (3.5 days vs. 5.8 days.). Preoperative SDOH diagnosis was shown to be independently predictive of a 1.67 day increase in hospital LOS following primary TEA (B = 1.67, SE 0.198). Preoperative SDOH diagnosis, though associated with many complications, was only shown to be independently predictive of postoperative cellulitis and UTI, indicating the presence of confounding variables associated with SDOH. SDOH were correlated with increased cost and independently predictive of increased LOS. These findings are crucial for both physicians and patients to evaluate before proceeding with TEA, as they highlight the significant healthcare resource demands linked to SDOH, a significant concern for a patient population already economically disadvantaged.