Social Determinants of Health Are Associated With 2-Year Implant Complications Following Total Elbow Arthroplasty.

Background

Social determinants of health (SDOH) may influence outcomes after total elbow arthroplasty (TEA), but associations with long-term implant-related complications are unclear. We evaluated the relationship between documented SDOH and: (1) 2-year implant-related complications after primary TEA; and (2) discharge disposition and 90-day health care utilization.

Methods

A retrospective matched cohort study was performed using a national insurance claims database (2010-2021). Primary TEA patients with 2 years or more of continuous follow-up were included. Social determinants of health exposure was defined using International Classification of Diseases, Ninth and Tenth Revision codes. Social determinants of health patients (N = 342) were matched 1:5 to controls (N = 1683) by age, sex, and overall Elixhauser Comorbidity Index. The outcomes evaluated included 2-year implant-related complications, non-home discharges, 90-day emergency department (ED) visits, and readmissions. Multivariable logistic regression computed odds ratios (ORs) of each outcome with 95% CIs. Significance was set at P < .01.

Results

Social determinants of health exposure was associated with higher odds of 2-year infection (OR, 2.01; 95% CI, 1.35-2.94; P = .0004) and elbow stiffness (OR, 1.74; 95% CI, 1.22-2.43; P = .001), with no significant differences in revision or other implant-related complications. Social determinants of health exposure was associated with higher odds of non-home discharges (OR, 1.82; 95% CI, 1.15-2.82; P = .008), while 90-day ED visits and readmissions were not significantly different between groups.

Conclusion

Documented SDOH were associated with increased 2-year infection and stiffness after TEA and higher odds of non-home discharges, without increased revision risk. LEVEL OF EVIDENCE III.