Sunday, May 26, 2013

Relationship of low income to surgical outcome

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty.

In past posts we discussed the "4Ps" that influence the result of surgery: the Problem (e.g. arthritis or massive cuff tear) , the Patient with the problem (e.g. age, gender, smoking, socioeconomic factors) , the Procedure to be performed (e.g. hemiarthroplasty, reverse total shoulder) and the Physician performing the procedure (e.g. extent of training, annual volume of similar cases).

This article focuses on the second P, socioeconomic factors and their relationship to the results of total knee replacement in young patients. The authors surveyed 661 patients 1 to 4 years after primary TKA for noninflammatory arthritis. While this study concerns total knees, its findings are likely to hold true for elective surgery as well.

They found that patients reporting incomes of less than $25,000 were less likely to be satisfied with  outcomes and more likely to have functional limitations than patients with higher incomes. At a lower level of association, women and minority patients were more likely to have functional limitations. Employment status and educational level at the least impact on satisfaction and function. The choice of implant did not have a significant effect on the outcome of surgery.

While much of our literature focuses on the type of procedure and the choice of implant, this study clearly demonstrates that the second P - the patient - has a strong influence on the result. Or as Osler said, "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has."

The reasons behind the association of low income with poorer outcome are as yet unknown. Readers may wish to visit a recent post regarding the relationship between revision and type of insurance. 

In an age of 'pay for performance', it will be essential that the incentives placed on good performance do not create an incentive to inappropriately avoid treating patients with lower incomes or those on Medicare and Medicaid.

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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

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