A new study in JBJS investigates the relationship between outcomes following total knee arthroplasty (TKA) and social determinants of health. Two of the authors, Tahsin M. Rahman, MD and Craig D. Silverton, DO, from Henry Ford Hospital in Detroit, Michigan, discuss their study in an Author Insights video. You can access the video and study at JBJS.org:
Notes Dr. Rahman, “in an urban environment such as the one we work in, we treat a wide demographic of patients. And it’s very clear that social factors can negatively impact [the] outcomes following total knee arthroplasty. However, we wanted to have more concrete and numeric data.”
Using the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database, the research team retrospectively identified more than 19,000 total knee arthroplasty cases and analyzed the relationship between outcomes and the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI).
As concluded by the investigators in their report, “Greater deprivation based on multiple SVI subthemes, the composite SVI, and the ADI was significantly associated with increased length of stay, non-home discharge ED visits, and readmissions. The SVI and the ADI may be important considerations in the perioperative assessment of patients who undergo TKA.”
Commenting in the video, Dr. Rahman adds, “I think ultimately it behooves us as the surgeons not only to operate on our patients but advocate for our patients, so figuring out pertinent interventions, I think that’s the next step.”
In their report, the researchers outline recommendations, including training of clinical staff in recognizing and understanding social determinants of health, support in accessing community and government resources, and practice-wide enhancements to improve postoperative care. “Surgeons are also accountable as advocates for equitable care at the community level. Lobbying politicians and engaging with local organizations and community planners can help to grow health equity programs and address structural societal inequalities,” they write.
Read the full study and watch the video: The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty. An Analysis of Neighborhood Deprivation Indices
