Frailty, Race/Ethnicity, Functional Status, and Adverse Outcomes After Total Hip/Knee Arthroplasty: A Moderation Analysis

Dharmasukrit, Charlie; Chan, Sut Yee Shirley; Tancredi, Daniel J.; Harvath, Theresa A.; Joseph, Jill G.

doi:10.1016/j.arth.2021.01.033

Cited by 21 publications

(18 citation statements)

References 44 publications

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“…Aseltine et al also reported that Black patients (OR = 1.68, p < 0.0001) and Hispanic patients (OR = 1.48, p < 0.0001) were significantly more likely to be readmitted within 30 days of discharge following a total joint arthroplasty than White patients 61 . Dharmasukrit et al reported that Black patients had 25% higher odds of readmission within 30 days compared with White patients (OR = 1.25; 95% CI, 1.13 to 1.34; p < 0.001) when controlling for frailty and 30% higher odds (OR = 1.30; 95% CI, 1.20 to 1.40; p < 0.001) of readmission within 30 days when controlling for functional status after TKA 62 .…”

Section: Resultsmentioning

confidence: 99%

“…The results of this review further show that there are significant disparities in outcomes after TJA among the different racial/ethnic groups. Black patients are more likely to have a higher number of comorbidities preoperatively and increased risk of major complications, readmissions, revisions, and discharge to institutional care (SNF or IRF) after TJA compared with White patients 44-88 . Hispanic patients are also more likely to have higher numbers of comorbidities preoperatively and an increased risk of complications and readmissions after TJA 44-88 .…”

Section: Discussionmentioning

confidence: 99%

“…In models controlling for frailty, Black patients had 8% longer LOS after TKA (p , 0.001) and 10% longer LOS after THA (p , 0.001) compared with White patients 62 and Hispanic (OR 5 1.16; 95%, CI 1.00 to 1.34) patients had a higher risk of readmission than White patients after THA when accounting for comorbidities and hospital factors 66 . White et al reported similar findings 67 .…”

Section: Readmission Riskmentioning

confidence: 99%

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Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty

et al. 2022

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Background: Previous studies have shown that utilization and outcomes of total joint arthroplasty (TJA) are not equivalent across different patient cohorts. This systematic review was designed to evaluate the currently available evidence regarding the effect that patient race has, if any, on utilization and outcomes of lower-extremity arthroplasty in the United States.Methods: A literature search of the MEDLINE database was performed using keywords such as "disparities," "arthroplasty," "race," "joint replacement," "hip," "knee," "inequities," "inequalities," "health," and "outcomes" in all possible combinations. All English-language studies with a level of evidence of I through IV published over the last 20 years were considered for inclusion. Quantitative and qualitative analyses were performed on the collected data.Results: A total of 82 articles were included. There was a significantly lower utilization rate of lower-extremity TJA among Black, Hispanic, and Asian patients compared with White patients (p , 0.05). Black and Hispanic patients had lower expectations regarding postoperative outcomes and their ability to participate in various activities after surgery, and they were less likely than White patients to be familiar with the arthroplasty procedure prior to presentation to the orthopaedic surgeon (p , 0.05). Black patients had increased risks of major complications, readmissions, revisions, and discharge to institutional care after TJA compared with White patients (p , 0.05). Hispanic patients had increased risks of complications (p , 0.05) and readmissions (p , 0.0001) after TJA compared with White patients. Black and Hispanic patients reached arthroplasty with poorer preoperative functional status, and all minority patients were more likely to undergo TJA at lowquality, low-volume hospitals compared with White patients (p , 0.05).Conclusions: This systematic review shows that lower-extremity arthroplasty utilization differs by racial/ethnic group, and that some of these differences may be partly explained by patient expectations, preferences, and cultural differences. This study also shows that outcomes after lower-extremity arthroplasty differ vastly by racial/ethnic group, and that some of these differences may be driven by differences in preoperative functional status and unequal access to care.Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. E lective total hip and knee arthroplasty (THA and TKA) are 2 of the most successful procedures for treating end-stage osteoarthritis (OA) 1,2 . However, the utilization of total joint arthroplasty (TJA) is not equivalent across different demographic subsets of patients in the United Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A816).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Readmission Riskmentioning

confidence: 99%

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Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty

et al. 2022

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“…For those who undergo such surgeries, several studies have reported that members of differing race/ethnicity groups—particularly Hispanic and Black patients—are less likely to receive total joint arthroplasty of the lower extremities when compared with White patients. 3-7 In perioperative adverse events, similar disparities exist, with several studies reporting worse functional outcomes and higher rates of postoperative complications in Hispanic and Black total joint arthroplasty patients when compared with White patients. 3-7…”

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confidence: 98%

“…3-7 In perioperative adverse events, similar disparities exist, with several studies reporting worse functional outcomes and higher rates of postoperative complications in Hispanic and Black total joint arthroplasty patients when compared with White patients. 3-7…”

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confidence: 98%

Racial/Ethnic Disparities in Physical Therapy Utilization After Total Knee Arthroplasty

Ratnasamy

Oghenesume

Rudisill

et al. 2023

J Am Acad Orthop Surg

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Background: Total knee arthroplasty (TKA) is a common orthopaedic procedure, after which many patients benefit from physical therapy (PT). However, such services may not be uniformly accessible and used. To that end, disparities in access to care such as PT after interventions may be a factor for those of varying race/ethnicities. Methods: TKAs were abstracted from the 2014 to 2016 Standard Analytic Files PearlDiver data set-a large national health administrative data set containing information on more than 60 million Medicare patients. Occurrences of home or outpatient PT within 90 days after TKA were identified. Patient demographic factors were extracted, including age, sex, Elixhauser Comorbidity Index, estimated average household income of patient based on zip code (low average household income [,75k/year] or high average household income [.75k/year]), and patient race/ethnicity (White, Hispanic, Asian, Native American, Black, or Other). Predictive factors for PT utilization were determined and compared with univariate and multivariate analyses. Results: Of 23,953 TKA patients identified, PT within 90 days after TKA was used by 18,837 (78.8%). Patients self-identified as White (21,824 [91.1%]), Black (1,250 [5.2%]), Hispanic (268 [1.1%]), Asian (241 [1.0%]), Native American (90 [0.4%]), or "Other" (280 [1.2%]) and were of low household income (19,957 [83.3%]) or high household income (3,994 [16.7%]). When controlling for age, sex, and ECI, PT was less likely to be received by those of low household income (relative to high household income OR 0.79) or by those of defined race/ethnicity (relative to White or Black OR 0.81, Native American OR 0.58, Asian OR 0.50, or Hispanic OR 0.44) (P , 0.05 for each). Discussion: In a large Medicare data set, disparities in utilization of PT after TKA were identified based on patient's estimated household income and race/ethnicity. Identification of such factors may help facilitate the expansion of care to meet the needs of all groups adequately.

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