JAAOS Plus Webinar: The Effect of Social Drivers of Health on 90-Day Readmission Rates and Costs After Primary Total Hip and Total Knee Arthroplasty
Tuesday, December 01, 2026 7:15 PM - 8:15 PM
Central Standard Time
Online
This webinar is an AAOS member benefit: Members attend for free!
Article Description
Introduction:
The effect of social drivers of health (SDOH) on readmissions and costs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is poorly understood. Policies such as the Hospital Readmissions Reduction Program have targeted overall readmission reduction, using value-based strategies to improve healthcare quality. However, the implications of SDOH on these outcomes are not yet understood. We hypothesized that the area deprivation index (ADI) as a surrogate for SDOH would markedly influence readmission rates and healthcare costs in the 90-day postprocedural period for THA and TKA.
Methods:
We used the 100% US fee-for-service Medicare claims data from 2019 to 2021. Patients were identified using diagnosis-related groups. Our primary outcomes included 90-day unplanned readmission after hospital discharge and cost of care, treated as “high cost” if > 1 standard deviation above the mean. The relationships between ADI and primary outcomes were estimated with logistic regression models.
Results:
A total of 628,399 patients were included in this study. The mean age of patients was 75.6, 64% were female, and 7.8% were dually eligible for Medicaid. After full covariate adjustment, readmission was higher for patients in more deprived areas (high Area Deprivation Index (ADI)) (low socioeconomic status (SES) group OR: 1.30 [95% confidence intervals 1.23, 1.38]). ADI was associated with high cost before adjustment (low SES group odds ratio 1.08 [95% confidence intervals 1.04, 1.11], P < 0.001), although, after adjustment, this association was lost.
Learning Objectives
- Identify key social drivers of health (SDOH) and describe how the Area Deprivation Index (ADI) is used to assess socioeconomic disadvantage in patients undergoing total hip and total knee arthroplasty.
- Examine the relationship between socioeconomic disadvantage and 90-day unplanned readmission rates following primary total hip and total knee arthroplasty.
- Evaluate the impact of social drivers of health on postoperative healthcare costs, including the influence of patient characteristics and other contributing factors.
- Discuss the implications of socioeconomic disparities for patient risk assessment, postoperative care planning, and efforts to reduce readmissions following total joint arthroplasty.
Director
Joshua Rozell, MD, FAAOS
Co-Authors
Christian Pean, MD, Lulla Kiwinda, BS, Mikhail Bethell, MD, MS, Amy Clark, PhD, Bradley Hammill, DrPH, Thorsten Seyler, MD, PhD, FAAOS
The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
If you are unable to attend the live webinar, you may still register to be notified upon the availability of the recorded session. Access to the recording will be granted for a duration of 2 years.