Social determinants of health and nonhome discharge for older adults undergoing primary total knee or hip arthroplasty

Background: Total joint arthroplasty (TJA) of the hip and knee are widely used surgical treatments for advanced cases of osteoarthritis. Despite its effectiveness, disparities in outcomes based on socioeconomic and geographic factors persist. The Area Deprivation Index (ADI), a measure of neighborhood-level socioeconomic disadvantage based on factors such as income, education, employment, and housing, is a valuable tool for understanding health disparities. This study examines the association between Area Deprivation Index (ADI) scores and postoperative outcomes, specifically non-home discharge and hospital length of stay (LOS), in adults aged 65 years and older undergoing TJA at a rural academic medical center. Unlike prior studies that have focused on urban populations or general surgical cohorts, this study uniquely examines how socioeconomic deprivation, measured by ADI, affects postoperative outcomes in rural older adults, a population often overlooked in health equity research. Methods: We performed a single center retrospective cohort study in a rural setting, analyzing 2117 cases aged 65 years and older who underwent primary TJA between 2017 and 2023, excluding 2020. ADI scores were used to quantify neighborhood-level socioeconomic deprivation. The primary outcome was non-home discharge, and the secondary outcome was long length of stay at hospital (LOS≥2 days), models of the outcomes were adjusted for age, sex, race, Charlson Comorbidity Index (CCI), year of surgery, and insurance class. Results: The median length of stay was 1 day (ranging between 0 and 37 days). Patients in the highest ADI tertile had increased odds of prolonged LOS (adjusted OR: 1.51; 95 % CI: 1.19–1.92) and nonhome discharge (adjusted OR: 1.49; 95 % CI: 1.08–2.07) compared to the lowest tertile. Conclusion: Higher ADI scores were associated with greater odds of long length of stay and nonhome discharges underscoring the need for interventions to address disparities and improve care for older adults undergoing TJA in rural areas.