title: Major elective joint replacement surgery: socioeconomic variations in surgical risk, postoperative morbidity and length of stay.
abstract: BACKGROUND
  Patient deprivation is associated with greater need for total hip and knee replacement surgery (THR/TKR) and a higher prevalence of risk factors for surgical complications. Our aim was to examine associations between deprivation and aspects of the inpatient episode for patients undergoing these procedures.
  
  
  METHODS
  We analysed socioeconomic variations in preoperative surgical risk, postoperative morbidity and length of stay for 655 patients undergoing elective THR/TKR at a large metropolitan hospital. Surgical risk was assessed using the orthopaedic version of the POSSUM scoring system, postoperative morbidity was assessed using the postoperative morbidity survey, and socioeconomic status was measured using the Index of Multiple Deprivation. We adjusted for age, sex, surgical site and primary vs. revision surgery.
  
  
  RESULTS
  We found only a modest, clinically insignificant socioeconomic gradient in preoperative surgical risk and no socioeconomic gradient in postoperative morbidity. There was a strong socioeconomic gradient in length of stay, but only for patients undergoing TKR. This was due to deprived patients being more likely to remain in hospital without morbidity following TKR.
  
  
  CONCLUSIONS
  Our findings suggest differential selection of healthier patients for surgery. Hospitals serving deprived communities may have excess, unfunded costs because of the increased length of stay of socioeconomically disadvantaged patients.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK. jennifer.hollowell@npeu.ox.ac.uk
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hollowell
authors.forename: Mike P W
authors.initials: MP
authors.lastname: Grocott
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardy
authors.forename: Fares S
authors.initials: FS
authors.lastname: Haddad
authors.forename: Monty G
authors.initials: MG
authors.lastname: Mythen
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D019992:Databases as Topic; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D008131:London; D008297:Male; D009017:Morbidity / Q000639:trends*; D011183:Postoperative Complications; D012923:Social Class; D013222:State Medicine