CORR finds ADI raises workload

Clinical Orthopaedics and Related Research published a study in 2026 examining whether neighborhood deprivation changes how much perioperative communication work orthopaedic practices do for primary total joint arthroplasty patients. The paper found that patients from more disadvantaged areas needed more practice-initiated communication around surgery, adding staff workload outside the operating room. (digitalcommons.kansascity.edu) The analysis covered more than 52,000 primary hip and knee arthroplasty patients treated at one high-volume urban academic institution between January 2016 and December 2022. A companion CORR Insights commentary by Wakenda K. Tyler was posted online on March 6, 2026. (pubmed.ncbi.nlm.nih.gov) ### What did the study actually measure? The study by Alan David Lam, Jessica H. Leipman and co-authors defined its primary outcome as the number of perioperative “touchpoints” per patient — communication points by telephone or electronic message sent or received on the patient’s behalf in relation to the arthroplasty procedure. The researchers asked whether touchpoint use differed across Area Deprivation Index, or ADI, quartiles, and also examined length of stay, readmissions and patient-reported outcome measures. The Area Deprivation Index is a neighborhood-level measure based on 17 census-derived markers of material deprivation and poverty, according to related arthroplasty literature cited in search results. (digitalcommons.kansascity.edu) In this study, the authors linked 2022 ADI rankings to patients’ street addresses and grouped patients from Quartile 1, the least disadvantaged, through Quartile 4, the most disadvantaged. ### How large was the dataset? The retrospective study started with 92,801 patients who underwent elective primary total hip arthroplasty or total knee arthroplasty for osteoarthritis. After excluding patients with non-osteoarthritis indications, missing ADI data, or incomplete minimum 90-day follow-up, the final analysis included 52,068 patients. (digitalcommons.kansascity.edu) Of those 52,068 patients, 22,363 underwent primary total hip arthroplasty and 29,705 underwent primary total knee arthroplasty. The mean age was 66 years, and 56% of the cohort were women, according to the abstract reposted by Kansas City University’s digital repository. (digitalcommons.kansascity.edu) ### Where did the 17% figure come from? Patients in the most disadvantaged ADI group required about 17% more practice-initiated touchpoints than patients in the least disadvantaged group, according to the study summary surfaced in research results and the social briefing provided for this story. The reported difference points to added clinic and administrative work tied to perioperative coordination, not just differences in surgical outcomes. (digitalcommons.kansascity.edu) The authors wrote that understanding how social determinants of health affect communication workload could help with resource planning and equitable patient engagement, particularly as more perioperative management takes place outside the hospital setting. (digitalcommons.kansascity.edu) That framing appears in the study abstract available through the Kansas City University repository. ### Why does ADI matter in this setting? The paper’s premise is that social deprivation may shape how much support patients need before and after surgery, even when the procedure itself is standardized. The authors said deficits in social determinants of health have already been linked to adverse clinical outcomes after primary THA and TKA, but perioperative communication workload had been less well characterized. (visualize.jove.com) Related arthroplasty studies indexed in PubMed and other journals have associated higher ADI with increased healthcare use, including complications, readmissions, emergency department use and resource utilization after hip or knee arthroplasty. (digitalcommons.kansascity.edu) This study extends that line of work into day-to-day operational burden inside orthopaedic practices. ### What did the commentary say practices should do differently? The social briefing tied to the CORR post said the commentary suggested tailoring outreach by patient group — for example, using video materials for lower-deprivation groups and more proactive direct contact for higher-deprivation groups. That approach was presented as a way to improve efficiency and equity in perioperative communication. (digitalcommons.kansascity.edu) Wakenda K. Tyler, identified by PubMed as the author of the CORR Insights commentary and an associate professor at Columbia University Medical Center, wrote the accompanying piece published alongside the article. PubMed lists the commentary as online ahead of print on March 6, 2026. (pubmed.ncbi.nlm.nih.gov) ### What comes next for readers who want the original paper? The full study appears in Clinical Orthopaedics and Related Research under the title “Higher Area Deprivation Index Is Associated With Greater Practice-initiated Perioperative Communication Workload in Patients With Primary Total Joint Arthroplasty,” authored by Lam, Leipman, Meacock, Parikh, Sherman, Fillingham and Krueger. (pubmed.ncbi.nlm.nih.gov) The companion commentary, “CORR Insights,” is indexed separately on PubMed under Wakenda K. Tyler’s name. (digitalcommons.kansascity.edu)