Ethnic Disparities and Incidence of Postoperative Complications in Obese Patients Undergoing Total Knee Arthroplasty: Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Set

Abstract

Introduction: Total knee arthroplasty (TKA) is common but complex operation. A paucity of literature exists on differences between Hispanics and non-Hispanics with TKA. Our study aims to investigate the association between Hispanic ethnicity and complications in obese patients undergoing TKA.Methods: This is a retrospective cohort study using the National Surgical Quality Improvement Program database for patients with body mass index $30 kg/m 2 who underwent TKA. Exposure in this study was ethnicity (Hispanic versus non-Hispanic), and the primary outcome was postoperative complications. Associations between ethnicity and baseline characteristics and between covariates and the outcome were assessed via bivariate analysis. Multiple logistic regression was done to determine associations between Hispanic ethnicity and complications while controlling for confounders.Results: Thirty five thousand twenty-seven patients were included in our study, of which 6.3% were Hispanic. Among obese adults, Hispanics had a 1.24 (95% CI 1.11 to 1.39) times greater odds of having a postoperative complication after TKA than non-Hispanics. This increased to 1.36 (95% CI 1.20 to 1.54) after adjusting for confounders. Hispanics were notably more likely to receive transfusion (2.62% vs. 1.59%, P , 0.001) and have prolonged length of stay (13.29% vs. 11.12%, P = 0.002) but were less likely to have wound disruption (0.05% vs. 0.27%, P = 0.042). Conclusion:In a national database, Hispanic ethnicity was associated with greater odds of postoperative complication in obese

National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery

“…15–17 Although medical and surgical management are important for care, recent evidence suggests that a person's socioeconomic factors impact outcomes and must be taken into account to optimize care. 7,8,13,18–20 The present study found that patients with educational deficiencies had increased rates of readmission and major complications compared with those without disparities following hip and ankle fracture management. Moreover, economic disparities were associated with an increased risk of readmission and revision following hip fixation and infection and readmission following ankle fracture surgery.…”

“…Previous literature has identified various factors of SDH associated with poor outcomes, such as race, insurance status, poor finances, and inadequate literacy, among others. 7,8,13,[18][19][20] Rubenstein et al 18 found that black race significantly negatively correlated with knee functional outcome when compared with white race following total joint arthroplasty. Education, gender, comorbidities, and neighborhood poverty were also found to be significantly associated with lower functional outcomes.…”