Reductions in Race and Ethnic Disparities in Hospital Readmissions Following Total Joint Arthroplasty from 2005 to 2015

Aseltine, Robert H.; Wang, Wenjie; Benthien, Ross A.; Katz, Matthew J.; Wagner, Catherine; Yan, Jun; Lewis, Courtland G.

doi:10.2106/jbjs.18.01112

Cited by 39 publications

(34 citation statements)

References 33 publications

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“…The reduction in this disparity, which ultimately led to Black and Hispanic patients having slightly lower estimated odds of admission than White patients, represents a major cost savings to the health care system as well as a step toward greater racial equity in orthopaedics. Aseltine et al 2 recently elucidated a similar trend, demonstrating a reduction in the readmission disparity between Black and White patients after total joint arthroplasty. This study represents the second example of a reduction in racial disparities in orthopaedics.…”

Section: Discussionmentioning

confidence: 62%

“…In particular, it is well documented that disparities exist in both access and outcomes after total hip and knee arthroplasty. § Medicare data from 1991 to 2008 as analyzed by Singh et al 33 indicated that racial disparities in access and outcome for both hip and knee arthroplasty failed to improve over that time period, whereas Aseltine et al 2 more recently found an encouraging reduction among Connecticut hospitals in the rates of disparate outcomes between White and Black patients after total hip arthroplasty from 2005 to 2015.…”

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confidence: 99%

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Decline in Racial Disparities for United States Hospital Admissions After Anterior Cruciate Ligament Reconstruction From 2007 to 2015

Bokshan

McGlone

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Racial disparities in perioperative complications have been shown to exist for many procedures in orthopaedic surgery. Although anterior cruciate ligament reconstruction (ACLR) is commonly performed as an outpatient procedure, the rate of admission to the hospital postoperatively is not insignificant. Hispanic patients have been shown to have higher odds of admission compared with non-Hispanic patients. Hypothesis: We hypothesized that racial disparities would decrease from 2007 to 2015, resulting in lower rates of hospital admission for Black and Hispanic patients. Study Design: Descriptive epidemiology study. Methods: This study represents a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database for patients undergoing ACLR between 2007 and 2015. We performed bivariate analysis as well as binary logistic regression, with postoperative admission as the primary outcome. Previously identified risk factors for admission were used as predictors in addition to a term for the statistical interaction between year of surgery and ethnicity. Results: A total of 7542 patients undergoing ACLR were assessed. The logistic regression model showed that Hispanic patients had higher overall odds of admission (odds ratio [OR], 3.320; P < .001) than White patients; Black patients also had higher odds compared with White patients (OR, 1.929; P = .009). However, there was a significant interaction between year of surgery and both Black ethnicity (OR, 0.907; P = .026) and Hispanic ethnicity (OR, 0.835; P = .002), indicating a significant decrease in the admission rates for these minority patients compared with White patients over time. Other risk factors for admission were the use of regional anesthesia (OR, 3.482; P < .001), bleeding disorders (OR, 5.064; P = .002), a higher body mass index (OR, 1.029; P < .001), and longer operative times (OR, 1.012; P < .001). More recent surgery was associated with lower odds of admission (OR, 0.826; P < .001). Conclusion: Admission rates after ACLR declined from 2007 to 2015. Black and Hispanic patients were more likely to be admitted overall, but they also saw a greater decrease in the odds of admission than White patients. This represents a reduction in disparity between the 2 groups and is a reassuring improvement in racial disparity trends after a common sports procedure.

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Section: Discussionmentioning

confidence: 62%

mentioning

confidence: 99%

Decline in Racial Disparities for United States Hospital Admissions After Anterior Cruciate Ligament Reconstruction From 2007 to 2015

Bokshan

McGlone

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Just as there is no single, simple reason for these unequal outcomes, there is no single, simple solution. The findings of Aseltine et al offer some hope [50]. Using claims data from the State of Connecticut, they estimated the rates of 30-day admissions after total hip and knee arthroplasty from 2005 to 2015.…”

Section: Discussionmentioning

confidence: 99%

What Factors Lead to Racial Disparities in Outcomes After Total Knee Arthroplasty?

Lee

et al. 2021

J. Racial and Ethnic Health Disparities

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Total knee arthroplasty (TKA) is one of the most commonly performed, major elective surgeries in the USA. African American TKA patients on average experience worse clinical outcomes than whites, including lower improvements in patient-reported outcomes and higher rates of complications, hospital readmissions, and reoperations. The mechanisms leading to these racial health disparities are unclear, but likely involve patient, provider, healthcare system, and societal factors. Lower physical and mental health at baseline, lower social support, provider bias, lower rates of health insurance coverage, higher utilization of lower quality hospitals, and systemic racism may contribute to the inferior outcomes that African Americans experience. Limited evidence suggests that improving the quality of surgical care can offset these factors and lead to a reduction in outcome disparities.

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“…Rather, there appears to be a multifaceted web of potential reasons (patient-level, provider-level, and system-level) that might explain why these racial and ethnic disparities in joint replacement have been so intransigent. Although multifaceted and complex, the outcomes reported by Okike et al (2019) and Aseltine et al (2019) are a testament to the reality that eliminating racial disparities is possible. Categories of factors attempting to explain variation among racial/ethnic groups have been identified as patient-specific, provider-specific, or system-related.…”

Section: Factors Associated With Racial Disparity In Arthroplasty Uti...mentioning

confidence: 99%

Time to Reflect and Take Action on Health Disparities and Health Inequities

Salmond

Dorsen

2022

Orthopaedic Nursing

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The United States healthcare system underperforms in healthcare access, quality, and cost resulting in some of the poorest health outcomes among comparable countries, despite spending more of its gross national product on healthcare than any other country in the world. Within the United States, there are significant healthcare disparities based on race, ethnicity, socioeconomic status, education level, sexual orientation, gender identity, and geographic location. COVID-19 has illuminated the racial disparities in health outcomes. This article provides an overview of some of the main concepts related to health disparities generally, and in orthopaedics specifically. It provides an introduction to health equity terminology, issues of bias and equity, and potential interventions to achieve equity and social justice by addressing commonly asked questions and then introduces the reader to persistent orthopaedic health disparities specific to total hip and total knee arthroplasty.

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Reductions in Race and Ethnic Disparities in Hospital Readmissions Following Total Joint Arthroplasty from 2005 to 2015

Cited by 39 publications

References 33 publications

Decline in Racial Disparities for United States Hospital Admissions After Anterior Cruciate Ligament Reconstruction From 2007 to 2015

Decline in Racial Disparities for United States Hospital Admissions After Anterior Cruciate Ligament Reconstruction From 2007 to 2015

What Factors Lead to Racial Disparities in Outcomes After Total Knee Arthroplasty?

Time to Reflect and Take Action on Health Disparities and Health Inequities

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