Social Determinants of Health Disparities Impact Postoperative Complications in Patients Undergoing Total Shoulder Arthroplasty

Document Type

Journal Article

Publication Date



Journal of shoulder and elbow surgery




Disparities; Social Determinants of Health; Surgical Complications; TSA; Total Shoulder Arthroplasty


BACKGROUND: Understanding the role of social determinants of health disparities (SDHD) in surgical outcomes can better prepare providers to improve postoperative care. In this study, we utilize International Classification of Diseases (ICD) codes to identify SDHD and investigate the risk of postoperative complication rates among patients undergoing total shoulder arthroplasty (TSA). METHODS: A retrospective cohort analysis was conducted using a national insurance claims database. Using ICD and Current Procedural Terminology (CPT) codes patients who underwent primary TSA with at least two years of follow-up in the database were identified. Patients with a history of SDHD were identified using appropriate ICD-9 and ICD-10 codes. Patients were grouped in one of two cohorts: (1) patients with no history of SDHD (Control) and (2) patients with a history of SDHD (SDHD group) prior to TSA. The SDHD and control groups were matched 1:1 for comorbidities and demographics prior to conducting multivariable analysis for 90-day medical complications and 2-year surgical complications. RESULTS: After matching, there were 8,023 patients in the SDHD group and 8,023 patients in the control group. The SDHD group had significantly higher odds for 90-day medical complications including heart failure, cerebrovascular accident, renal failure, deep vein thrombosis, pneumonia, sepsis, and urinary tract infection. Additionally, the SDHD group had significantly higher odds for revision surgery within 2-years following TSA. Patients in the SDHD group also had a significantly longer length of hospital stay following TSA. DISCUSSION: This study highlights the association between SDHD and postoperative complications following TSA. Quantifying the risk of complications and differences in length of stay for TSA patients with a history of SDHD is important in determining value-based payment models and risk stratifying to optimize patient care.


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