Social Determinants of Health Disparities Increase the Rate of Complications After Total Knee Arthroplasty

Document Type

Journal Article

Publication Date



The Journal of arthroplasty




Health Disparities; PearlDiver; Postoperative Complications; Social Determinants of Health; Total Knee Arthroplasty


BACKGROUND: Few studies have investigated whether social determinants of health disparities (SDHD), which include economic, social, education, healthcare, and environmental factors, identified through International Classification of Diseases (ICD) codes are associated with increased odds for poor health outcomes. We aimed to investigate the association between SDHD, identified through this novel methodology, as well as postoperative complications following total knee arthroplasty (TKA). METHODS: Using a national insurance claims database, a retrospective cohort analysis was performed. Patients were selected using Current Procedural Terminology and ICD codes for primary TKA between 2010 and 2019. Patients were stratified into two groups using ICD codes, those who had SDHD and those who did not, and propensity matched 1:1 for age, sex, a comorbidity score, and other comorbidities. After matching, 207,844 patients were included, with 103,922 patients in each cohort. Odds ratios (ORs) for 90-day medical and 2-year surgical complications were obtained using multivariable logistical regressions and subsequently used to calculate the number need to be exposed for one additional person to be harmed. RESULTS: In patients who have SDHD, multivariable analysis demonstrated higher odds of readmission (OR): 1.12; P=0.013) and major and minor medical complications (OR: 2.09; P<0.001) within 90-days as well as higher odds of revision surgery (OR: 1.77; P<0.001) and periprosthetic joint infection (OR: 1.30; P<0.001) within 2-years. CONCLUSION: The SDHD are an independent risk factor for revision surgery and periprosthetic joint infection after TKA. In addition, SDHD is also an independent risk factor for all-cause hospital readmissions and both minor and major complications.


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