Racial Disparity in the Perioperative Care for Patients Undergoing Total Knee and Hip Arthroplasty: A Retrospective Propensity-Matched Cohort Study

Elsharydah, Ahmad; Embabi, Ahmed S.; Minhajuddin, Abu; Joshi, Girish P.

doi:10.1007/s40615-017-0409-2

Cited by 25 publications

(17 citation statements)

References 24 publications

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“…Elsharydah et al found that a propensity matched cohort of black patients had higher rates of 30 day complications for lower extremity arthroplasty. 10 Several studies have found that hospital factors such as safety net burden impact surgical outcomes. [31][32][33][34][35] Hoehn et al 21 reported that high safety net burden hospitals had higher postsurgical mortality and LOS; subgroup analysis of THA patients found increased costs with procedures performed at high burden hospitals but no mortality or readmissions difference.…”

Section: Discussionmentioning

confidence: 99%

“…6 Evidence supports the association between THA outcomes and multifactorial patient-level, provider-level and hospital-level racial and socioeconomic disparities. [7][8][9][10][11][12][13][14][15][16] Hospital safety net burden is defined as the proportion of cases at an individual hospital with the primary insurance payer being Medicaid or uninsured; safety net hospitals operate with a mandate or adopted mission to deliver care to patients regardless of their ability to pay. 17 18 Research shows higher rates of mortality, hospitalacquired infection, perioperative complications and poorer markers of surgical quality (timeliness, patient centeredness and equity of treatment) at high safety net burden hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Hospital safety net burden is associated with increased inpatient mortality and postoperative morbidity after total hip arthroplasty: a retrospective multistate review, 2007–2014

Tangel

Gupta

et al. 2019

Reg Anesth Pain Med

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BackgroundTotal hip arthroplasty (THA) is one of the most widely performed surgical procedures in the USA. Safety net hospitals, defined as hospitals with a high proportion of cases billed to Medicaid or without insurance, deliver a significant portion of their care to vulnerable populations, but little is known about the effects of a hospital’s safety net burden and its role in healthcare disparities and outcomes following THA. We quantified safety net burden and examined its impact on in-hospital mortality, complications and length of stay (LOS) in patients who underwent THA.MethodsWe analyzed 500 189 patient discharge records for inpatient primary THA using data from the Healthcare Cost and Utilization Project’s State Inpatient Databases for California, Florida, New York, Maryland and Kentucky from 2007 to 2014. We compared patient demographics, present-on-admission comorbidities and hospital characteristics by hospital safety net burden status. We estimated mixed-effect generalized linear models to assess hospital safety burden status’ effect on in-hospital mortality, patient complications and LOS.ResultsPatients undergoing THA at a hospital with a high or medium safety net burden were 38% and 30% more likely, respectively, to die in-hospital compared with those in a low safety net burden hospital (high adjusted OR: 1.38, 95% CI 1.10 to 1.73; medium adjusted OR: 1.30, 95% CI 1.07 to 1.57). Compared with patients treated in hospitals with a low safety net burden, patients treated in high safety net hospitals were more likely to develop a postoperative complication (adjusted OR: 1.11, 95% CI 1.00 to 1.24) and require a longer LOS (adjusted IRR: 1.06, 95% CI 1.05, 1.07).ConclusionsOur study supports our hypothesis that patients who underwent THA at hospitals with higher safety net burden have poorer outcomes than patients at hospitals with lower safety net burden.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital safety net burden is associated with increased inpatient mortality and postoperative morbidity after total hip arthroplasty: a retrospective multistate review, 2007–2014

Tangel

Gupta

et al. 2019

Reg Anesth Pain Med

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“…In terms of co-morbidities that can affect the outcomes, diabetes is worrying, given the comprehensive literature linking diabetes to elevated complication rates in TJA patients [35][36][37][38]. Racial inequalities are multifactorial, with patient, provider, and device variables as contributing factors [39]. Many of these contributing factors are possibly modifiable, but further research is required to pinpoint them.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Total Joint Arthroplasty in Black, Asian, Minority Ethnic Groups Versus Local Population: A Retrospective Review

Khan¹,

Ali²,

Bhambani³

et al. 2021

Cureus

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Background: Total hip and knee replacement decrease the disability caused by osteoarthritis of the lower extremities. Although it has been established that racial and ethnic minorities underutilize these procedures, little data on postoperative outcomes exists. The impact of race on postoperative Oxford scores and complications following total joint arthroplasty (TJA) will be investigated in this retrospective review. Methods: A retrospective review of 120 elective primary TJA procedures was undertaken between January 2016 and December 2019 in a single institution. To measure variations between the various groups, t-tests were used on their Oxford scores, and chi-squared bivariate regression was used to classify all categorical variables and the association of ethnicity and surgery type with gender. Results: There were 62 (51.6%) White patients and 59 (49.1.0%) Black, Asian, Minority Ethnic (BAME) patients in total. The majority of the patients were females (60.9% vs 39.2%, p = 0.032). Low vitamin D levels were seen in a small percentage of patients in the sample (15.8% vs 84.2%, p = 0.460). There is a statistically important connection (p = 0.001) between the surgery type (total knee replacement [TKR]/total hip replacement [THR]) and gender; 41 females had TKR surgery, and 32 had THR surgery. Conclusion: The study found that the relationships between ethnicity (White/BAME) and gender as well as surgery type (TKR/THR) and gender are statistically important. In all cases with low vitamin D and normal vitamin D levels, White patients had higher overall Oxford hip scores than the BAME patients. To comprehend the differences discovered, further research is needed. To try to eliminate the difference, targeted approaches should be created.

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“…On the other hand, not all studies have demonstrated an association between patient ethnicity and the use of neuraxial analgesia. For example, in a retrospective propensity-matched study of adults undergoing knee and hip replacement surgery, ethnic-based differences in the use of neuraxial analgesia were not observed after controlling for several important demographic and clinical factors (Elsharydah et al, 2018). This raises the possibility that in patient groups with relatively similar preoperative characteristics, such as ours, the association between the use of epidural analgesia and patient ethnicity may be less significant.…”

Section: Discussionmentioning

confidence: 99%

A retrospective evaluation of the impact of patient ethnicity on the use of epidural analgesia or blood transfusions in children undergoing major oncologic surgery

et al. 2019

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Background The impact of patient ethnicity on healthcare delivery is well documented. In this study of children who had undergone open abdominal or pelvic surgery for tumor resection, we sought to compare the use of epidural analgesia or intraoperative blood transfusions between Caucasian and non-Caucasian children. Methods A retrospective study of 139 children was performed. Logistic regression models were used to evaluate the association between the specified perioperative factors and patient ethnicity. Results The average age (standard deviation) was 11 years (± 5), 50% were female, and 58% were Caucasian. Compared to Caucasian children, non-Caucasian children were younger (difference in mean, − 2.6 years; 95% confidence interval [− 4.3, − 0.9], p = 0.003), underwent shorter procedures (difference in mean anesthesia minutes, − 134; 95% confidence interval [− 230, − 39], p = 0.006), and had a lower proportion of patients who received epidural analgesia (66% versus 81%, p = 0.042) or blood transfusions (48% versus 65%, p = 0.039). In the adjusted model, patient ethnicity was not associated with the receipt of epidural analgesia (odds ratio 0.53, 95% confidence interval [0.23, 1.21], p = 0.132) or blood transfusions (odds ratio 0.77, 95% confidence interval [0.29, 2.04], p = 0.600). The use of epidural analgesia or blood transfusions was associated with abnormal coagulation factors (odds ratio 0.32, 95% confidence interval [0.14, 0.71], p = 0.005) and the duration of surgery (odds ratio 1.007, 95% confidence interval [1.005, 1.009], p < 0.001), respectively. Conclusion In this study of children who had undergone major oncologic surgery, the use of epidural analgesia or blood transfusions was not associated with patient ethnicity.

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Racial Disparity in the Perioperative Care for Patients Undergoing Total Knee and Hip Arthroplasty: A Retrospective Propensity-Matched Cohort Study

Cited by 25 publications

References 24 publications

Hospital safety net burden is associated with increased inpatient mortality and postoperative morbidity after total hip arthroplasty: a retrospective multistate review, 2007–2014

Hospital safety net burden is associated with increased inpatient mortality and postoperative morbidity after total hip arthroplasty: a retrospective multistate review, 2007–2014

Outcomes of Total Joint Arthroplasty in Black, Asian, Minority Ethnic Groups Versus Local Population: A Retrospective Review

A retrospective evaluation of the impact of patient ethnicity on the use of epidural analgesia or blood transfusions in children undergoing major oncologic surgery

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