背景:鉴于对患者预后的日益重视,包括术后并发症,在全关节置换术(TJA)中,调查门诊关节置换术的兴起是有必要的。由于再次入院和并发症发生率的增加,人们担心在同一天将患者出院回家的安全性。然而,心理上的益处和较低的费用为门诊关节置换术提供了动力.健康差异的社会决定因素对门诊关节成形术的影响仍未被探索。一个评估社会差距的指标,包括以下各个组成部分:社会经济地位,家庭组成,少数民族地位,住房和交通,是社会脆弱性指数(SVI)。因此,我们的目的是比较:(1)住院和门诊关节置换术患者的平均总SVI和各部分的平均SVI,以及(2)总并发症的危险因素.
方法:确定在2022年1月1日至2022年12月31日期间接受TJA的患者。数据来自马里兰州住院患者数据库(SID)。在这段时间内,共有7817名患者患有TJA。患者分为住院关节置换术(n=1429)和门诊关节置换术(n=6338)。针对每个主题评分,比较住院和门诊手术之间的平均SVI。SVI根据四个主题得分确定了可能需要外部对人类健康压力的支持的社区:社会经济地位;家庭组成和残疾;少数民族地位和语言;以及住房和交通。SVI使用美国人口普查数据对每个主题的人口普查范围进行排名,以及整体社会脆弱性得分。SVI越高,社会越脆弱,或在该地区蓬勃发展所需的资源。在控制了危险因素和患者合并症后,进行了多因素logistic回归分析,以确定TJA术后总并发症的独立危险因素。总并发症包括:感染,无菌性松动,位错,关节纤维化,机械性并发症,疼痛,和假体周围骨折。
结果:住院关节置换术患者的总体SVI评分较高(0.45vs.0.42,P<0.001)。因社会经济地位而住院的关节置换术患者的SVI评分较高(0.36vs.0.32,P<0.001),少数民族地位和语言(0.76vs.0.74,P<0.001),以及住房和交通(0.53vs.0.50,P<0.001)与门诊关节置换术相比,分别。住院和门诊关节置换术在家庭组成和残疾方面没有差异(0.41vs.0.41,P=0.99)。当控制合并症时,住院患者关节置换术[赔率比(OR)1.91,95%置信区间(CI)1.23-2.95,P=0.004],高血压(OR2.11,95%CI1.23-3.62,P=0.007),住房和交通(OR2.00,95%CI1.17-3.42,P=0.012)是总并发症的独立危险因素。
结论:住院关节置换术与剥夺的几个组成部分之间的社会差异增加有关,并且是TJA后总并发症的独立危险因素。据我们所知,这项研究是首次通过社会差异的视角来检查住院患者关节成形术的负面影响,并且可以针对特定的干预领域。
BACKGROUND: Given the growing emphasis on patient outcomes, including postoperative complications, in total joint arthroplasty (TJA), investigating the rise of outpatient arthroplasty is warranted. Concerns exist over the safety of discharging patients home on the same day due to increased readmission and complication rates. However, psychological benefits and lower costs provide an incentive for outpatient arthroplasty. The influence of social determinants of health disparities on outpatient arthroplasty remains unexplored. One metric that assesses social disparities, including the following individual components: socioeconomic status, household composition, minority status, and housing and transportation, is the Social Vulnerability Index (SVI). As such, we aimed to compare: (1) mean overall SVI and mean SVI for each component and (2) risk factors for total complications between patients undergoing inpatient and outpatient arthroplasty.
METHODS: Patients who underwent TJA between January 1, 2022 and December 31, 2022 were identified. Data were drawn from the Maryland State Inpatient Database (SID). A total of 7817 patients had TJA within this time period. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). The mean SVI was compared between inpatient and outpatient procedures for each themed score. The SVI identifies communities that may need support cause by external stresses on human health based on four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. The SVI uses the United States Census data to rank census tracts for each individual theme, as well as an overall social vulnerability score. The higher the SVI, the more social vulnerability, or resources needed to thrive in that area. Multivariate logistic regression analyses were performed to identify independent risk factors for total complications following TJA after controlling for risk factors and patient comorbidities. Total complications included: infection, aseptic loosening, dislocation, arthrofibrosis, mechanical complication, pain, and periprosthetic fracture.
RESULTS: Patients who had inpatient arthroplasty had higher overall SVI scores (0.45 vs. 0.42, P < 0.001). The SVI scores were higher for patients who had inpatient arthroplasty for socioeconomic status (0.36 vs. 0.32, P < 0.001), minority status and language (0.76 vs. 0.74, P < 0.001), and housing and transportation (0.53 vs. 0.50, P < 0.001) compared to outpatient arthroplasty, respectively. There was no difference between inpatient and outpatient arthroplasty for household composition and disability (0.41 vs. 0.41, P = 0.99). When controlling for comorbidities, inpatient arthroplasty [Odds Ratio (OR) 1.91, 95% Confidence Interval (CI) 1.23-2.95, P = 0.004], hypertension (OR 2.11, 95% CI 1.23-3.62, P = 0.007), and housing and transportation (OR 2.00, 95% CI 1.17-3.42, P = 0.012) were independent risk factors for total complications.
CONCLUSIONS: Inpatient arthroplasty was associated with increased social disparities across several components of deprivation as well as an independent risk factor total complications following TJA. To the best of our knowledge, this study is the first to examine the negative repercussions of inpatient arthroplasty through the lens of social disparities and can target specific areas for intervention.