Neighborhood socioeconomic disadvantage does not predict outcomes or cost after elective shoulder arthroplasty

Background: There is growing evidence that the variation in value of shoulder arthroplasty may be mediated by factors external to sur-gery. We sought to determine if neighborhood-level socioeconomic deprivation is associated with postoperative outcomes and cost among patients undergoing elective shoulder arthroplasty.Methods: We identified 380 patients undergoing elective total shoulder arthroplasty (anatomic or reverse) between 2015 and 2018 in our institutional registry with minimum 2-year follow-up. Each patient's home address was mapped to the area deprivation index in order to determine the level of socioeconomic disadvantage. The area deprivation index is a validated composite measure of 17 census variables encompassing income, education, employment, and housing conditions. Patients were categorized into 3 groups based on so-cioeconomic disadvantage (least disadvantaged [deciles 1-3], middle group [4-6], and most disadvantaged [7-10]). Bivariate analysis was performed to determine associations between the level of socioeconomic deprivation with hospitalization time-driven activity -based costs and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and pain intensity scores.Results: Overall 19% of patients were categorized as most disadvantaged. These patients were found to have equivalent preoperative pain intensity (P = .51), SANE (P = .50), and ASES (P = .72) scores compared to the middle and least disadvantaged groups, as well as similar outcome improvement at 2 years postoperatively (ASES): least disadvantaged group [35.7-84.3], middle group [35.1-82.4], and most disadvantaged group [37.1-84.0] [P = .56]; SANE: least disadvantaged group [31.8-87.1], middle group [30.8-84.8], and most disadvantaged group [34.2-85.1] [P = .42]; and pain: least disadvantaged group [6.0-0.97], middle group [6-0.97], and most disadvan-taged group [5.6-0.80] [P = .88]. No differences in hospitalization costs were noted between groups (P = .77).Conclusions: Patients undergoing elective shoulder arthroplasty residing in the most disadvantaged neighborhoods demonstrate equiv-alent preoperative and postoperative outcomes as others, without incurring higher costs. These findings support continued efforts to pro-vide equitable access to orthopedic care across the socioeconomic spectrum.Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.