These authors sought to characterize the role of socioeconomic status (SES) in 982 patients undergoing primary anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis (OA).
They assessed patient demographics, comorbidities, patient-reported outcome scores, range of motion, and preoperative opioid use. Each patient was assigned to a quartile according to the Area Deprivation Index (ADI) using their home address (see this link).
The map for Texas shows a huge variation in the ADI, ranging from most disadvantaged
(dark red) to least disadvantaged (blue).
They found that the most disadvantaged patients (lower SES) had
a higher body mass index
higher rates of preoperative opioid use
higher rates of diabetes.
more preoperative pain (Constant—Pain and American Shoulder and Elbow Surgeons [ASES]—Pain) and
lower function (Constant—ADL, Constant—Total, and ASES).
Multivariate regression identified that male patients and advanced age at surgery had better reported ASES pain scores, while preoperative opioid use, chronic back pain, and the most disadvantaged quartile were associated with worse ASES pain scores.
Comment: This study provides a means for stratifying an important characteristic of patients having shoulder arthroplasty: their socioeconomic status. The authors suggest that the area deprivation index is a better measure of socioeconomic status than insurance status alone because its methodology accounts for factors such as income/poverty, education, employment, housing, and occupation.
A notable finding of this study is that SES was directly correlated with the preoperative patient assessed comfort and function as shown below
This is important because preoperative ASES score is recognized as a strong predictor of the postoperative ASES score.
This study suggests that patients who are identified as socioeconomically disadvantaged are likely to benefit from preoperative attention to their overall health, nutrition, pain management and home support systems.
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Here are some videos that are of shoulder interest
