The impact of socioeconomic deprivation on total shoulder arthroplasty outcomes.

Background: Total shoulder arthroplasty (TSA) is a highly effective surgical intervention to alleviate pain and restore function in various shoulder joint pathologies. As the demand for TSA continues to rise, it is important to understand patient factors that affect clinical outcomes. The Area Deprivation Index (ADI) quantifies socioeconomic deprivation, accounting for multiple variables including income, education, employment, and housing quality. The purpose of this study is to examine the effects of socioeconomic deprivation on patient outcomes after TSA. Methods: A retrospective chart review was performed on patients who received TSA from January 2007 to December 2022. Records were reviewed for demographic factors including age, sex, race, body mass index, and Charlson Comorbidity Index. Postoperative outcomes included active forward flexion and active external rotation along with visual analog scale pain scores and American Shoulder and Elbow Surgeons (ASES) scores. Socioeconomic deprivation was evaluated through ADI scores from the Neighborhood Atlas. Chi-squared and analysis of variance tests were performed for analysis. Results: In this study, 955 patients were included, with 426 receiving anatomic TSA (aTSA) and 529 receiving reverse TSA (rTSA) cohort. Among aTSA patients, 32% were least, 52% intermediate, and 16% most deprived. For rTSA, 27% of patients were least, 59% intermediate, and 13% most. The aTSA cohort saw significant differences among socioeconomic groups in postoperative active external rotation at 6 months (most deprived [47.0°] >> intermediate [44.6°], least [43.9°]), and postoperative ASES at the most recent follow-up (most deprived [76.5] << least [89.4], intermediate [80.4]). There were also differences in mean pain scores at 3 months (most deprived [2.9] >> least [1.4], intermediate [1.7]), 1 year (most deprived [3.1] >> least [1.3], intermediate [1.7]), and the most recent follow-up (most deprived [2.9] >> intermediate [2.0] >> least [1.2]). The rTSA cohort saw significant differences among socioeconomic groups in preoperative ASES (most deprived [24.3] << intermediate [32.0], least [35.8]). Differences in mean pain score were also significant at preoperative (most deprived [6.6] >> intermediate [5.6] >> least [4.7]) and 1 year time points (most deprived [2.6] >> intermediate [1.6], least [1.4]). Conclusion: Some interval postoperative disparities highlight the impact of socioeconomic deprivation, with most deprived patients having worse outcomes in TSA cohorts. While outcomes were generally similar at the most recent follow-up, prospective studies are needed to more accurately elucidate differences. Nevertheless, incorporating ADI metrics care could maximize optimal outcomes in shoulder arthroplasty.