Abstract
Introduction
Social determinants of health (SDOH) may contribute markedly to the total cost of care (COC) for patients undergoing elective total knee arthroplasty (TKA). This study investigated the association between demographics, health status, and SDOH on lengths of stay (LOS) and 30-day COC.
Methods
Patients who underwent TKA between January 2018 and December 2019 were identified. Those who had complete SDOH data were utilized, leaving 234 patients. Data elements were drawn from the Chesapeake Regional Information System, the Center for Disease Control social vulnerability index (SVI), the Food Access Research Atlas (FARA). The SVI identifies areas vulnerable to catastrophic events, with 4 themed scores including: (1) socioeconomic status; (2) household composition and disability; (3) minority status and language; and (4) housing and transportation. Food deserts were defined as neighborhoods located 1 or 10 miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine an association with LOS and cost, after controlling for demographics.
Results
Increased 30-day COC associated with SVI theme 3, (3.074 days; p=0.001) and patients who lived in a food desert ($53,205; p=0.001), as well as those who had anemia ($16,112; P = 0.038), chronic obstructive pulmonary disease ($32,570, P = 0.001), congestive heart failure ($30,927, P = 0.003), and dementia ($33,456, P = 0.008). Longer hospital lengths of stay were associated with SVI theme 3. In addition, patients who had anemia and congestive heart failure were at risk for longer hospital lengths of stay (P < 0.001, P = 0.001, respectively)
Conclusion
Higher SVI theme 3 scores and living in food deserts were risk factors for increased LOS and costs, respectively. Identifying social factors including a patient's transportation options, living situation and access to healthy foods may prove to be both prognostic of outcomes and an opportunity for intervention.
