Defining Racial and Ethnic Disparities in THA and TKA

Irgıt, Kaan; Nelson, Charles L.

doi:10.1007/s11999-011-1885-z

Cited by 55 publications

(41 citation statements)

References 38 publications

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“…Others have reported minorities have less access to TKA [52,58]. Lower utilization of TKA by patients with fewer resources has also been reported [24,27]. Dunlop et al [17], on the other hand, reported, although there were lower rates of TKA among minority patients, this pattern was not seen in those younger than 65 years, which was the age of our patient population.…”

Section: Discussionsupporting

confidence: 51%

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

Barrack¹,

Ruh²,

Chen³

et al. 2014

Clinical Orthopaedics &Amp; Related Research

137

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Background Few data exist regarding the impact of socioeconomic factors on results of current TKA in young patients. Predictors of TKA outcomes have focused primarily on surgical technique, implant details, and individual patient clinical factors. The relative importance of these factors compared to patient socioeconomic status is not known. Questions/purposes We determined whether (1) socioeconomic factors, (2) demographic factors, or (3) implant factors were associated with satisfaction and functional outcomes after TKA in young patients. MethodsWe surveyed 661 patients (average age, 54 years; range, 18-60 years; 61% female) 1 to 4 years after undergoing modern primary TKA for noninflammatory arthritis at five orthopaedic centers. Data were collected by an independent third party with expertise in collecting healthcare data for state and federal agencies. We examined specific questions regarding satisfaction, pain, and function after TKA and socioeconomic (household income, education, employment) and demographic (sex, minority status) factors. Multivariable analysis was conducted to examine the relative importance of these factors for each outcome of interest. One of the authors certifies that he (RLB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Smith & Nephew, Inc, and an amount of more than USD 1,000,001 from Stryker Orthopaedics. One of the authors certifies that he (AVL) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc, and an amount of USD 10,000 to 100,000 from Innomed, Inc (Savannah, GA, USA). One of the authors certifies that he (KRB) has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Biomet Inc.One of the authors certifies that he (JP) has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Smith & Nephew, Inc, an amount of USD 10,000 to 100,000 from 3 M, an amount of USD 10,000 to 100,000 from Cadence Pharmaceuticals, Inc (San Diego, CA, USA), an amount of USD 10,000 to 100,000 from CeramTec (Laurens, SC, USA), an amount of USD 10,000 to 100,000 from Pfizer (New York, NY, USA), an amount of USD 10,000 to 100,000 from Salient Surgical (Minneapolis, MN, USA), an amount of USD 10,000 to 100,000 from TissueGene (Rockville, MD, USA), and an amount of USD 10,000 to 100,000 from Zimmer Inc. One of the authors certifies that he (CDV) has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Biomet Inc, an amount of USD 10,000 to 100,000 from Smith & Nephew, Inc, an amount of less than USD 10,000 from ConvaTec (Skillman, NJ, USA), and an amount of less than USD 10,000 from CD Diagnostics (Wynnewood, PA, USA). One of the authors certifies that he (WGH) has or may receive payments or benefits, during the study period, an amount of USD 100,001 to 1,000,000 from DePuy, a Johnson and Johnson company, and an amount of USD 1...

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Section: Discussionsupporting

confidence: 51%

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

Barrack¹,

Ruh²,

Chen³

et al. 2014

Clinical Orthopaedics &Amp; Related Research

137

View full text Add to dashboard Cite

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“…6,10,11,12 Of note, most prior studies have focused on the field of joint arthroplasty 10,11,12 and comparatively little work has been conducted with respect to the effect of race, ethnicity, or socioeconomic status on outcomes, morbidity, or mortality following elective spine surgery.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Race on Outcomes of Surgical or Nonsurgical Treatment of Patients in the Spine Patient Outcomes Research Trial (SPORT)

Schoenfeld

Lurie²,

Zhao³

et al. 2012

Spine

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Study Design Retrospective review of the data collected prospectively through the Spine Patient Outcomes Research Trial (SPORT). Objective Determine the effect that race or ethnicity had on outcomes following spine surgery in the three arms of SPORT. Summary of Background Data There is a dearth of research regarding the effect of race or ethnicity on outcome following treatment for spinal disorders. Methods All participants from the three arms of the SPORT were evaluated in an as-treated analysis with patients categorized as white, black, or other. Baseline and operative characteristics of the groups were compared using the chi-square test and ANOVA. Differences in the changes between baseline and 1-, 2-, 3-, and 4-year time-points in the operative and non-operative treatments were evaluated with a mixed effects longitudinal regression model and differences between racial groups were compared with a multiple degrees of freedom Wald test. Results Included were 2,427 patients (85% white, 8% black, 7% other). Surgery was performed on 67% of white patients, 54% of blacks, and 68% of others. Whites and others were significantly more likely to undergo surgery than blacks (67% and 68% vs 54%, p=0.003). Complications and the risk of additional surgeries were not significantly different between racial groups. Regardless of race, all patients improved more with surgical management than with nonoperative treatment for all outcome measures at all time-points. The average 4-year area- under-the-curve results revealed surgical and non-operative treatment resulted in statistically significant improvement in whites relative to blacks for BP (p<0.001), SF (p<0.001), and ODI (p<0.001). No significant differences were appreciated in treatment effect for primary outcome measures or self-rated progress across racial groups. Conclusion These results illustrate important differences between racial groups in terms of response to spine care. While there were quantitative differences between groups, these findings are not necessarily indications of healthcare disparities.

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“…For elective cases such total knee arthroplasty (TKA), studies have noted that there may be cultural barriers to African- American patients undergoing TKA [37][38][39]. However, symptoms associated with CES are severe and result in patients seeking out care.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

Jain

Menga

Mesfin

2017

J. Racial and Ethnic Health Disparities

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Cauda equina syndrome (CES) is a surgical emergency requiring urgent spinal decompression. Our objective is to analyze the association between race and in-hospital outcomes (complications, mortality, length of stay, and discharge disposition) in patients with CES. This is a retrospective cohort study of CES patients identified via the Nationwide Inpatient Sample (NIS) from 2000 to 2010 in inpatient hospitalizations in the USA. The patient sample includes 46,017 patients ≥18 undergoing spine surgery for CES. Using ICD9-CM codes, patient records with a diagnosis of CES from 2003 to 2010 were selected from the NIS database and sorted by mortality, complications, length of hospital stay, and discharge status. Demographic information (age, gender, race, and insurance status) and hospital characteristics were evaluated. African-American patients were 1.38-fold (p < 0.02; 95% odds ratio [OR] 1.05-1.83) more likely than Caucasian patients to develop complications based on a multivariate logistic regression model adjusted for patient age, insurance status, surgical approach, and hospital size. There was no difference in mortality among patients of various races in both univariate and multivariate analysis. A multivariate linear regression model adjusted for insurance status, surgical approach, and hospital size revealed that, compared to Caucasian patients, length of hospitalization in African-American patients was 1.92 days longer (p < 0.01), 1.34 days longer (p < 0.01) in Hispanic patients, and 2.24 days longer (p < 0.01) in Asian-American patients. African-American patients were 0.59-fold (p < 0.01; 95% OR 0.494-0.708) less likely than Caucasian patients to have routine discharge to home. African-American patients hospitalized for surgical management of CES experience significantly more complications, longer length of hospitalizations, and higher discharge to non-home locations, compared to Caucasian patients.

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Defining Racial and Ethnic Disparities in THA and TKA

Cited by 55 publications

References 38 publications

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

The Effect of Race on Outcomes of Surgical or Nonsurgical Treatment of Patients in the Spine Patient Outcomes Research Trial (SPORT)

Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

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