Lower socioeconomic status is not associated with worse 2-year outcomes following reverse total shoulder arthroplasty

Background The aim of this study was to evaluate the association between area deprivation index(ADI) and patient outcomes following reverse total shoulder arthroplasty(rTSA). Methods A retrospective analysis of patients who underwent a rTSA at a single institution between 2011-2021 with minimum 2-year follow-up. Each patient's home address was mapped to the ADI to determine the level of socioeconomic(SE) disadvantage. Patients were categorized into 5-groups based on socioeconomic-status(SES): ADI group-1; the least deprivation and ADI group-5; the most deprivation. Bivariate analysis was performed to determine the association between the level of SES and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score. Multivariable regression analysis was utilized to assess the role of independent variables in achieving MCID, SCB and PASS for ASES. Results A total of 551-patients, mean age:71.1±9.1 y/o and overall mean follow-up time of 42.5±29.9 months. The mean ADI value of all cohorts was 49.3±29.4. The mean ADI for groups one through five were: 9.0 ±4.9, 30.1 ±7.6, 47.6 ±4.4 70.9 ±6.7 and 89.9 ±5.2. There were no differences in age, sex, BMI, or preoperative medical comorbidities. The average preoperative ASES score across ADI subgroups was 30.6±18.0. Preoperative ASES scores were lowest in both ADI group 1:26.5±15.3 and ADI group 5:25.9±16.7. There was no difference in preoperative ROM across all ADI subgroups. The average postoperative ASES score was 74.2±23.7. There was a significant inverse relationship between ADI and postoperative ASES (p=0.047). ADI group-1 had the highest postoperative ASES score of 78.6±21.6 compared to 70.0±24.1 in group-5. There was no difference in change pre-to postoperative ASES scores across ADI subgroups with an average delta ASES score of 42.8±26.2. Like preoperative ROM there was no difference across ADI subgroups in terms of postoperative ROM. The average percentage of the cohort of patients across ADI subgroups that achieved MCID, SCB and PASS for ASES was 87.6%, 68.9%, and 57.5%, respectively. There was no difference in terms of achieving MCID, SCB or PASS for ASES across ADI subgroups. Conclusion The current study supports an inverse relationship between ADI and postoperative outcomes in patients undergoing rTSA. Additionally, our study found that a patient's ability to achieve MCD, SCB, or PASS for ASES at a minimum of 2-years after rTSA was not dependent on socioeconomic status. Lastly, our study demonstrated that the risk of suffering an AE or undergoing a revision surgery were not associated with socioeconomic status.