MARGINALIZATION INFLUENCES ACCESS, OUTCOMES, AND DISCHARGE DESTINATION FOLLOWING TOTAL JOINT REPLACEMENT IN CANADA'S UNIVERSAL HEALTHCARE SYSTEM

The influence of socioeconomic status (SES) or marginalization on outcomes and complications from total joint arthroplasty (TJA) in the context of the Canadian single-payer healthcare system has yet to be elucidated. The objectives of the current study are to evaluate the impact of SES on TJA surgery outcomes and complications. A population-based cohort study was conducted using a combination of the prospectively collected hospital-based TJA database, and the Canadian Institute of Health Information (CIHI) Discharge Abstract Database. The primary independent variable was the average census marginalization index to infer the patient's SES. The primary dependent variable was functional outcome scores collected at 1-year postoperatively utilizing the Oxford Hip and Knee Scores (OKS/OHS). Multivariate linear regressions were performed to identify independent predictors associated with minimal important difference (MID) of 1-year postoperative OKS/OHS compared to pre-operative, and discharge to an inpatient facility. A consecutive series of 7,286 TJA events were included for analysis. Demographic and outcome characteristics differed significantly across marginalization quintiles. When compared to the highest quintile, quintiles IV and V had significantly lower preoperative and postoperative OKS/OHS scores. When compared to the first quintile, patients in quintile V were significantly older (67.1±9.8 vs. 69.3±10.4, Mean Difference [MD] = 2.2, p 0.5). Patients who are most marginalized received their TJA later in life, had worse preoperative function, experienced worse postoperative function and were more likely to be discharged to another inpatient facility. Identifying patient populations that may benefit from dedicated care pathways will be a valuable tool to increase access to care, improve patient outcomes and reduce health care expenditures.