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The Impact of Lower Socioeconomic Status and Total Shoulder Arthroplasty

Lower Socioeconomic Status Is Associated with Worse Preoperative Function, Pain, and Increased Opioid Use in Patients with Primary Glenohumeral Osteoarthritis

 

https://sa1s3.patientpop.com/assets/docs/159761.pdf

 

Sheth MM, Morris BJ, Laughlin MS, Elkousy HA, Edwards TB.

J Am Acad Orthop Surg 2020;28: 287-292

DOI: 10.5435/JAAOS-D-19-00490

 

Abstract

Background: Numerous studies have identified differences in patient-reported outcome scores and complication rates based on various measures of socioeconomic status (SES); however, there is limited information regarding the role of SES in the shoulder arthroplasty cohort. The purpose of this study was to characterize the role of SES in patients undergoing primary anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis (OA).

 

Methods: We identified 1,045 patients who had primary total shoulder arthroplasty done for shoulder joint arthritis (OA) in a prospective shoulder arthroplasty registry, and 982 patients met inclusion criteria. We prospectively assessed patient demographics, comorbidities, patient-reported outcome scores, range of motion, and preoperative opioid use. Each patient was assigned to a quartile according to the Area Deprivation Index using their home address as a measure of SES.

 

Results: The most disadvantaged patients (lower SES) reported to our center with a higher body mass index and higher rates of preoperative opioid use and diabetes. Patients in the most disadvantaged quartile reported more preoperative pain (Constant—Pain and American Shoulder and Elbow Surgeons [ASES]—Pain) and lower function (Constant—ADL, Constant—Total, and ASES). Multivariate regression identified that male patients and advanced age at surgery had better reported ASES pain scores, while preoperative opioid use, chronic back pain, and the most disadvantaged quartile were associated with worse ASES pain scores.

 

Conclusion: Lower SES correlates with worse preoperative function and pain in patients undergoing anatomic primary total shoulder arthroplasty for primary glenohumeral OA. Providers should be cognizant of the potential impact of SES when evaluating quality metrics for patients with primary glenohumeral OA.

 

Level of Evidence: Level 3, cross-sectional study.

 

Shoulder Q&A with Dr. Brent J. Morris, MD a shoulder replacement specialist in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine.

 

Who is Dr. Brent J. Morris?

Dr. Brent J. Morris is an orthopedic shoulder and elbow surgeon in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine. Dr. Morris is a fellowship-trained shoulder and elbow specialist with additional interest in primary and revision total shoulder replacement surgery.  Dr. Morris is co-author of a textbook devoted to total shoulder, reverse total shoulder, and revision shoulder replacement surgery, Shoulder Arthroplasty, 2ndEdition.

 

What is shoulder joint arthritis?

Shoulder joint arthritis or primary glenohumeral joint osteoarthritis (OA) as we refer to in this article is a common cause of shoulder joint pain.  Shoulder joint arthritis is similar to hip and knee arthritis, which most people are probably more familiar with.  Shoulder joint arthritis is not quite as common as hip and knee arthritis because the hip and knee joints see lots of weight bearing loads when we walk.

 

What are treatment options for shoulder joint arthritis?

Shoulder joint arthritis can often be treated non-surgically with light exercises, stretching, NSAIDs, and sometimes steroid injections into the joint.  Unfortunately, sometimes the arthritis can progress to the point that these non-surgical measures are no longer effective to provide pain relief.  The shoulder joint arthritis can often start to impact sleep.  Total shoulder replacement is a reasonable option once these non-surgical options have failed.  We know that some patients may have earlier access to care for things like shoulder joint arthritis and we performed this investigation to look into this further.

 

More information on treatment options for shoulder joint arthritis:

https://www.brentmorrismd.com/blog/i-have-shoulder-arthritis-what-are-my-options-for-treatment

 

More information on sleep disturbance with shoulder joint arthritis and improvements after shoulder replacement:

https://www.brentmorrismd.com/blog/shoulder-arthritis-and-trouble-sleeping-does-this-improve-after-shoulder-replacement-surgery

 

 

Why did your group tackle this important question?

We have often wondered how much socioeconomic variables can impact the preoperative presentation of patients with shoulder joint arthritis, but there is limited data to guide us.  Many recognize that patients with less financial resources and social support networks can have added difficulties gaining access to care for many conditions.  The work of our team does appear to show that access to care issues can be relatable to orthopedic issues such as shoulder joint arthritis as well.

 

What did you and your team find?

By looking at a robust population of over 1,000 patients, we found that patients with lower socioeconomic status presented with worse preoperative function and worse pain.  These patients also had higher preoperative opioid use for shoulder arthritis pain.

 

Our conclusion noted, “The results of this study support our hypothesis that patients of lower SES undergoing primary anatomic TSA for glenohumeral OA have worse preoperative function and pain, higher rates of opioid usage, and a higher rate of diabetes mellitus. In addition, lower

SES was correlated with higher BMI. We also identified a trend toward higher rates of chronic back pain, depression, and heart disease based on lower SES.”

 

 “Lower SES correlates with worse preoperative function and pain, as well as higher rates of opioid usage, higher BMI, and diabetes mellitus in patients undergoing anatomic TSA for primary glenohumeral OA. The ADI has potential in research to control for the influence of SES on PROs. Surgeons, primary care providers and payers should be cognizant of the potential impact of SES when treating or evaluating quality metrics for patients with primary glenohumeral OA.”

 

How will thing study change your practice?

I think that it serves as an important reminder to some of the barriers that our patients face.  We need to recognize and overcome these barriers to improve access to health care, including orthopedic care.

 

About Dr. Morris:

Dr. Brent J. Morris is a board-certified orthopedic surgeon and fellowship-trained shoulder and elbow specialist in Lexington, Kentucky at Baptist Health Lexington – Orthopedics and Sports Medicine.  Dr. Morris is a fellow of the American Academy of Orthopedic Surgeons (FAAOS) and an Active Member of American Shoulder and Elbow Surgeons (ASES). Dr. Morris and his research team have published extensively on shoulder surgery and ways to improve outcomes and patient satisfaction following surgery.  He is co-author of a textbook devoted to total shoulder, reverse total shoulder replacement surgery, and revision shoulder replacement surgery, Shoulder Arthroplasty, 2ndEdition (https://www.elsevier.com/books/shoulder-arthroplasty/edwards/978-0-323-53164-1). 

 

For more information about Dr. Morris, visit online at www.brentmorrismd.com.

Brent J. Morris, MD

Board-Certified Orthopedic Surgeon

Orthopedic Shoulder and Elbow Surgeon

Shoulder Replacement and Revision Shoulder Replacement Specialist

Baptist Health Lexington – Orthopedics and Sports Medicine

Fellow American Academy of Orthopaedic Surgeons (FAAOS)

Active Member American Shoulder and Elbow Surgeons (ASES)

Author
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