Social determinants of health predict increased length of stay but not complications following primary total shoulder arthroplasty in Medicaid patients

Abstract

Introduction

Social determinants of health (SDOHs) are nonmedical influences on healthcare, including sociocultural and economic factors. The purpose of this study was to determine if preoperative International Classification of Disease, tenth revision (ICD-10) code diagnoses of SDOH were predictive of increased complication following primary total shoulder arthroplasty (TSA) in Medicaid patients.

Methods

The National Readmissions Database was queried from 2016 to 2020 to identify Medicaid patients with preoperative diagnoses of SDOH (n = 275) and Medicaid patients without preoperative diagnoses of SDOH (n = 5297) undergoing elective primary TSA. Regression analysis was used to identify independent predictors of complications, increased cost, and increased hospital length of stay (LOS).

Results

Diagnoses of SDOH were correlated with increased odds of 180-day readmission and mortality, increased surgical site infection, and increased cost and LOS. Following regression analysis, diagnoses of SDOH were not independently predictive of any complication, readmission, or mortality, but were predictive of increased LOS.

Conclusion

ICD-10 code diagnoses of SDOH were independently predictive of increased LOS in Medicaid patients undergoing primary TSA, but were not independently predictive of complications, readmission, mortality, or increased cost. This study focused on a population with less economic variance than previous studies. In a population economically disadvantaged, these findings provide insightful considerations for physicians and patients given the increased resource utilization associated.

Level of evidence: Level III – Retrospective cohort study.