A Systematic Review of the Social Determinants of Health in Shoulder Arthroplasty Outcomes

Research Mentor Name

Dr. Michael Gaudiani

Institution / Department

Henry Ford Health System

Document Type

Research Abstract

Research Type


Level of Research



This systematic review investigates the impact of social determinants of health (SDOH) on outcomes in shoulder arthroplasty (SA). SA, a common orthopedic procedure, has seen an increasing focus on SDOH influencing postoperative results. The study aims to comprehensively assess this impact on both surgical and patient-reported outcomes.

Through a systematic search of databases, 34 studies (2011-2021) met the inclusion criteria, involving 4,825,547 patients. Explored SDOH included insurance status, race/ethnicity, age, sex, income, social support, and veteran status. Outcomes considered were length of stay, American Shoulder and Elbow Surgeons scores, total SA rates, revision rates, complication rates, and discharge status.

Findings revealed associations between non-white race, female sex, and increased high-impact and bothersome chronic pain. Risk factors for dislocations post-SA included male sex, morbid obesity, cardiovascular abnormalities, depression, opioid use disorder, and tobacco use. Higher age, private health insurance, primary surgery, absence of chronic alcoholism, retired or lightly physically working patients correlated with higher satisfaction.

Discussion highlights that SDOH factors (younger age, female gender, non-white race) are linked to prolonged operative time, increased pain, and higher postoperative complication risks. Insurance, work status, and primary surgery impact patient satisfaction post-SA. Overall, demographic factors significantly affect TSA outcomes and complications, emphasizing the need for further research and addressing healthcare barriers to improve patient care. Orthopedic surgeons and policymakers should recognize these SDOH implications for future patient management.


Medicine and Health Sciences | Orthopedics | Social Justice

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