Comparison of Area Deprivation Index, Socioeconomic Parameters, and Preoperative Demographics with Postoperative Emergency Department Visits following Total Knee Arthroplasty

Abstract Background This study aims to determine if socioeconomic (SE) parameters, primarily area deprivation index (ADI), relate to postoperative emergency department (ED) visits following total knee arthroplasty (TKA). Methods We retrospectively reviewed 2655 patients who underwent TKA in a health system of 4 hospitals. The primary outcome was an ED visit within 90 days, which was divided into those with and without readmission. SE parameters including ADI as well as preoperative demographics were analyzed. Univariable and multiple logistic regressions were performed determining risk of 90-day postoperative ED visits, as well as once in the ED, risks for readmission. Results 436 patients (16.4%) presented to the ED within 90 days. ADI was not a risk factor. The multiple logistic regression demonstrated males, Medicare or Medicaid, and preoperative ED visits were consistently risk factors for a postoperative ED visit with and without readmission. Preoperative anticoagulation was only a risk factor for ED visits with readmission. Amongst patients who visited the ED, if the patient was Caucasian, a lower BMI, or higher ASA score, they were likely to be readmitted. Conclusion The study demonstrated that the percentage of early ED returns following TKA were high and that ADI was not a predictor for 90-day postoperative ED visit. The only SE factor that may contribute to this phenomenon was insurance type. Once in the ED, race, preoperative ED visits, preoperative anticoagulation, BMI, gender and preoperative ASA score contributed to a risk of readmission. The study supports hospitals mission to provide equal access healthcare.