The impact of social deprivation on reverse total shoulder arthroplasty outcomes

Abstract

Background: Social deprivation has previously been shown to have a negative correlation with patients' overall health. In addition, higher levels of social deprivation have been shown to be correlated with poor postoperative outcomes following orthopedic procedures and health-care-related quality of life. The purpose of this study is to evaluate how a patient's level of social deprivation level, as measured by the Area Deprivation Index (ADI), affects patients with rotator cuff arthropathy (RCA) and their experience with reverse total shoulder arthroplasty (rTSA).

Methods: A retrospective review, with an evidence level of 3, composed of 119 patients (133 shoulders) with primary RCA who underwent rTSA by a single surgeon at a single institution from 2005-2020. Social deprivation was determined using the patient's ADI score. Preoperative and postoperative range of motion, visual analog scale scores, American Shoulder and Elbow Surgeon scores, Constant-Murley Scores, and Simple Shoulder Test scores were recorded for each patient. Patients were grouped into terciles based on their level of social deprivation and comparisons were made between the groups. Analysis of variance and student t-testing were used to determine statistically significant differences between the groups.

Results: Significant functional improvements were observed following rTSA for patients with RCA. Preoperatively, patients from the most deprived group showed lower average Simple Shoulder Test scores (1.62 vs. 3.04, P = .026), while postoperatively, these patients showed lower external rotation with their arm at the side (33° vs. 42°, P = .044). Otherwise, there were no significant differences in pain or functional outcomes between the ADI groups preoperatively or postoperatively. Notching and postoperative complication rates were also not statistically different between the 3 groups (P = .886 and P = .697, respectively).

Conclusion: rTSA is a safe and effective procedure for patients from all levels of social deprivation, and patients can experience similar postoperative shoulder pain and function regardless of their socioeconomic status.

Keywords: Area deprivation index; Health disparities; Orthopedic surgery; Patient-reported outcomes; Reverse shoulder arthroplasty; Rotator cuff arthropathy; Social deprivation; Socioeconomic status.

Figure 1

ADI tercile vs. pain score. ADI, Area Deprivation Index.

Figure 2

ADI tercile vs. range of motion. ADI, Area Deprivation Index.

Figure 3

ADI tercile vs. Constant–Murley and ASES scores. ASES, American Shoulder and Elbow Surgeons; ADI, Area Deprivation Index.

Figure 4

ADI tercile vs. simple shoulder test scores. ADI, Area Deprivation Index.