Background: A greater area deprivation index (ADI), a tool that gauges socioeconomic disadvantage at the neighborhood level, is associated with worse health care outcomes following primary total hip arthroplasty. However, its association with revision total hip arthroplasty (rTHA) is unknown. This study aimed to determine the association between ADI and rates of postoperative health care resource utilization following rTHA.

Methods: A total of 996 patients who underwent rTHA between 2016 and 2022 were enrolled in a prospective study. The primary outcomes assessed were nonhome discharge disposition (DD), length of stay (LOS) ≥ three days, 90-day emergency department (ED) visits, and 90-day hospital readmissions. The ADI was calculated using the patient's home address at the time of surgery, with greater ADI indicating greater socioeconomic disadvantage. We evaluated the mediation effect of patient race on ADI and postoperative health care utilization using a multivariable logistic regression model.

Results: A higher median ADI was revealed for patients who experienced nonhome discharge (P = 0.001), extended LOS (P < 0.001), and ED readmission within 90 days of surgery (P = 0.045). When comparing septic versus aseptic rTHA patients, there were significant differences in health care resource utilization but no difference in ADI between the two groups. For aseptic rTHA, ADI significantly mediated the effect of race on both nonhome DD and LOS ≥ 3 (41 and 46% mediation, respectively). In septic rTHA, ADI mediated 31.1% of the effect of race on nonhome DD, but showed minimal mediation effect on LOS. The mediation effect of ADI on ED admission and hospital readmission was minimal for both groups.

Conclusions: Higher ADI scores are associated with increased health care utilization after rTHA, including longer hospital stays and more nonhome discharges. The ADI significantly mediates the effect of race on these outcomes, particularly in aseptic rTHA cases, suggesting that neighborhood socioeconomic factors play a crucial role in previously observed racial disparities.

Keywords: area deprivation index; discharge disposition; length of stay; readmission; revision total hip arthroplasty.

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背景： 更大的区域剥夺指数（ADI），这是一种衡量社区层面经济社会劣势的工具，与初次全髋关节置换术后的医疗保健结果更差有关。然而，其与翻修全髋关节置换术（rTHA）的关系尚不清楚。本研究旨在确定ADI与rTHA术后医疗保健资源利用率之间的关联。

方法： 共有996名患者在2016年至2022年间接受了rTHA，并被纳入前瞻性研究。评估的主要结果指标包括非家庭出院去向（DD）、住院时间（LOS）≥3天、术后90天内急诊科（ED）就诊次数以及术后90天内的再入院情况。ADI是根据患者手术时的家庭地址计算得出的，ADI值越大表示经济社会劣势越严重。我们使用多变量逻辑回归模型评估了种族对ADI和术后医疗保健利用之间的中介效应。

结果： 对于经历非家庭出院、延长住院时间以及术后90天内ED再入院的患者，其中位ADI值更高（P = 0.001, P

结论： 较高的ADI得分与rTHA后的医疗资源利用增加有关，包括更长的住院时间和更多的非家庭出院情况。ADI在种族对这些结果的影响上具有显著的中介作用，特别是在无菌性rTHA的情况下，表明社区经济社会因素是之前观察到的种族差异的重要原因。

关键词： 区域剥夺指数；出院去向；住院时间；再入院；翻修全髋关节置换术。