Primary Total Knee and Total Hip Arthroplasty in the Rural Patient.

Rural patients have poorer health indicators, including higher risk of developing osteoarthritis. The objective of this study is to compare rural patients undergoing primary total joint arthroplasty (TJA) at rural hospitals with those undergoing primary TJA at urban hospitals with regards to demographics, comorbidities, and complications and to determine the preferred location of care for rural patients. Data from the Healthcare Cost and Utilization Project National Inpatient Sample between 2016 and 2018 were analyzed. Demographics, comorbidities, inpatient complications, hospital length of stay, inpatient mortality, and discharge disposition were compared between rural patients who underwent TJA at rural hospitals and urban hospitals. Rural patients undergoing primary TJA in rural hospitals were more likely to be women, to be treated in the South, to have Medicaid payer status, to have dementia, diabetes mellitus, lung disease, and postoperative pulmonary complications, and to have a longer hospital length of stay. Those patients were also less likely to have baseline obesity, heart disease, kidney disease, liver disease, cancer, postoperative infection, and cardiovascular complications, and were less likely to be discharged home. Rural patients undergoing primary TJA tend to pursue surgery in their rural hospital when their comorbidity profile is manageable. These patients get their surgery performed in an urban setting when they have the means for travel and cost, and when their comorbidity profile is more complicated, requiring more specialized care, Rural patients are choosing to undergo their primary TJA in urban hospitals as opposed to their local rural hospitals. (Journal of Surgical Orthopaedic Advances 33(2):061-067, 2024).

Distal Humerus Fractures in Adults: Comorbidity Patterns and Demographic Trends in Treatment.

The purpose of the study was to (1) assess the prevalence of comorbidities and (2) compare demographics of surgically and non-surgically treated distal humerus fracture patients. Retrospective review of data from a national database was performed. The primary outcome was comorbidities; the secondary outcome was demographic trends between treatment groups. Distal humerus fractures are associated with cerebrovascular disease, dementia, diabetes mellitus, heart disease, hyperlipidemia, hypertension, hypothyroidism, kidney disease, liver disease, and lung disease. Those undergoing surgery are more likely to be obese, under the age of 40 years, female, Medicare recipients with fewer comorbidities, who reside in a rural setting, and who seek care at urban/teaching hospitals within the Southern United States. They are also more likely to have a shorter hospital stay, to be discharged to home, and to have improved survival. (Journal of Surgical Orthopaedic Advances 32(1):017-022, 2023).