The Effect of Socioeconomic Status and Social Deprivation on Outcomes Following Reverse Shoulder Arthroplasty: Data From an Urban Academic Center

Haley N Tornberg; Caroline T Gutowski; Evan Derector; Nicholas D'Antonio; James Gaston; Emily P Kleinbart; Matthew T Kleiner; Catherine J Fedorka

doi:10.5435/JAAOS-D-24-01352

The Effect of Socioeconomic Status and Social Deprivation on Outcomes Following Reverse Shoulder Arthroplasty: Data From an Urban Academic Center

J Am Acad Orthop Surg. 2025 May 6. doi: 10.5435/JAAOS-D-24-01352. Online ahead of print.

Authors

Haley N Tornberg¹, Caroline T Gutowski, Evan Derector, Nicholas D'Antonio, James Gaston, Emily P Kleinbart, Matthew T Kleiner, Catherine J Fedorka

Affiliation

¹ From the Cooper Medical School of Rowan University, Camden, NJ (Tornberg, Gutowski, Derector, Kleiner, and Fedorka), the Cooper University Hospital, Camden, NJ (D'Antonio, Kleiner, and Fedorka) the Case Western Reserve University School of Medicine, Cleveland, OH (Gaston), and the Albert Einstein College of Medicine, Bronx, NY(Kleinbart).

PMID: 40344656
DOI: 10.5435/JAAOS-D-24-01352

Abstract

Purpose: Rotator cuff tear arthropathy (CTA) and glenohumeral osteoarthritis pose notable financial and symptomatic burdens on the aging population. This study aims to determine how social determinants of health affect patient-reported outcomes following reverse total shoulder arthroplasty (rTSA), the surgical treatment for cuff tear arthropathy and glenohumeral osteoarthritis.

Methods: A single-center retrospective review was conducted for patients who underwent rTSA between 2017 and 2022. Zip codes were used to determine income levels, as defined by the U.S. Department of Housing and Urban Development (HUD) and the Federal Reserve (FED). Social disadvantage was quantified using Social Deprivation Index (SDI). The American Shoulder and Elbow Score (ASES) was obtained by chart review or calls at a minimum 2-year follow-up. Statistical analysis was notable done using analysis of variance, Kruskal-Wallis, and Pearson chi-square tests.

Results: A total of 121 patients met inclusion criteria. Of those included, 101 patients (83%) had 2-year ASES scores. Patients were divided into three cohorts based on HUD income status, FED income status, and SDI score. A difference was observed in 2-year ASES scores when stratified by HUD subgroups (P = 0.011); however, no difference was observed in 2-year ASES scores between FED or SDI subgroups. Analysis yielded no differences in pain scores, range of motion, total length of hospital stay, complications, or revision rates between all subgroups (all, P > 0.05).

Discussion: The results of this study yielded no notable difference in postoperative ASES scores between FED classes or SDI subgroups. Although a difference was observed in ASES scores between HUD classes, it may be clinically negligible. Contrary to previous literature, socioeconomic status and social deprivation did not affect postoperative outcomes within our patient population.

Conclusion: Social determinants of health did not affect outcomes of patients undergoing a rTSA within the first 2 years after surgery.

Level of evidence: III.