Does Neighborhood Deprivation Impact Readmission and Associated Costs After Hip Fracture Surgery?

INTRODUCTION: In the context of value-based care, the influence of racial and socioeconomic factors on hip fracture care outcomes remains underexplored. This study investigates the association of the area deprivation index (ADI) on readmission rates and Centers for Medicare and Medicaid Services (CMS) payments following hip fracture surgery. METHODS: We conducted an analysis using United States Medicare fee-for-service claims from 2019 to 2021, identifying patients hospitalized for hip fracture surgery based on Diagnosis-Related Groups criteria. Our primary outcomes were 90-day unplanned readmissions and CMS payments. ADI was our primary exposure of interest, calculated at the census block level. The analysis adjusted for multiple factors using logistic regression models. RESULTS: The study included 248,691 patients with an average age of 82.3 ± 8.5 years. We noted a 20.7% (51,603/248,691) rate of 90-day unplanned readmissions. Adjusted findings showed a modest, independent association between unplanned readmission and neighborhood deprivation, especially in the most deprived groups (OR: 1.26 [95% CI 1.19, 1.35]). Fully adjusted analysis showed a null association between CMS payments and neighborhood deprivation. Black race had a stronger association with unplanned 90-day readmissions (OR: 1.06 [95% CI 1.00, 1.13]) compared to White race. Males had a stronger association with readmission (OR: 1.26 [95% CI 1.24, 1.29]) and higher CMS payments (OR: 1.07 [95% CI 1.06, 1.07]) compared to females. CONCLUSION: Neighborhood deprivation is independently associated with higher odds of unplanned 90-day readmission after hip fracture surgery, though no significant association with CMS payments was identified. These findings support the need to address social drivers of health in clinical care and inform value-based payment and policy reform aimed at reducing disparities.

Duke Scholars

Author Malcolm R DeBaun Orthopaedic Surgery

Author Christian Pean Orthopaedic Surgery

Author Bradley Gordon Hammill Population Health Sciences