Rural-urban differences in characteristics, postoperative outcomes, and costs for patients undergoing knee arthroplasty: a national retrospective propensity score matched cohort study

Abstract

Background: The rural-urban disparities in postoperative complications and costs among patients undergoing knee arthroplasty (KA) have not been thoroughly explored. This study aimed to determine whether such differences exist in this patient population. Material and Methods: The study was conducted using data from the national Hospital Quality Monitoring System of China. Hospitalized patients undergoing KA from 2013 to 2019 were enrolled. Patient and hospital characteristics were compared between rural and urban patients, and differences in postoperative complications, readmissions, and hospitalization costs were analyzed using propensity score matching. Results: Of the 146 877 KA cases analyzed, 71.4% (104 920) were urban patients and 28.6% (41 957) were rural patients. Rural patients tended to be younger (64.4±7.7 years vs. 68.0±8.0 years; P<0.001) and had fewer comorbidities. In the matched cohort of 36 482 participants per group, rural patients were found to be more likely to experience deep vein thrombosis (OR: 1.31, 95% CI: 1.17–1.46; P<0.001) and require red blood cell (RBC) transfusion (OR: 1.38, 95% CI: 1.31–1.46; P<0.001). However, they had a lower incidence of readmission within 30 days (OR: 0.65, 95% CI: 0.59–0.72; P<0.001) and readmission within 90 days (OR: 0.61, 95% CI: 0.57–0.66; P<0.001) than their urban counterparts. In addition, rural patients incurred lower hospitalization costs than urban patients (57 396.2 Chinese Yuan vs. 60 844.3 Chinese Yuan; P<0.001). Conclusion: Rural KA patients had different clinical characteristics compared with urban patients. While they had a higher likelihood of deep vein thrombosis and RBC transfusion following KA than urban patients, they had fewer readmissions and lower hospitalization costs. Targeted clinical management strategies are needed for rural patients.