Fear in Arthroplasty Surgery: The Role of Race

Lavernia, Carlos J.; Alcerro, Jose C.; Contreras, Juan S.; Rossi, Mark D.

doi:10.1016/j.arth.2010.01.065

Cited by 13 publications

(21 citation statements)

References 15 publications

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“…Minorities receiving Medicare or with private insurance were also more likely to receive institutional care. Several studies have reported that minorities and individuals with lower SES have poorer function preoperatively (likely due to delaying the procedure) and are more at risk for postoperative complications following joint replacement (41–45). The findings of these studies may be one explanation for those instances when minorities and individuals of lower SES received more intensive care.…”

Section: Discussionmentioning

confidence: 99%

Disparities in post-acute rehabilitation care for joint replacement

Freburger¹,

Holmes²,

Ku³

et al. 2011

Arthritis Care Res

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Objectives To determine the extent to which demographic and geographic disparities exist in the use of post-acute rehabilitation care (PARC) for joint replacement. Methods Cross-sectional analysis of two years (2005–2006) of population-based hospital discharge data from 392 hospitals in four states (AZ, FL, NJ, WI). 164,875 individuals 45 years and older admitted to the hospital for a hip or knee joint replacement and who survived their inpatient stay were identified. Three dichotomous dependent variables were examined: 1) discharge to home vs. institution (i.e., skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF)); 2) discharge to home with vs. without home health (HH); and 3) discharge to a SNF vs. IRF. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use, controlling for illness severity/comorbidities, hospital characteristics, and PARC supply. Interactions among race, socioeconomic, and geographic variables were explored. Results Considering PARC as a continuum from more to less intensive care in regard to hours of rehabilitation/day (e.g., IRF→SNF→HH→no HH), the uninsured received less intensive care in all three models. Individuals on Medicaid and those of lower SES received less intensive care in the HH/no HH and SNF/IRF models. Individuals living in rural areas received less intensive care in the institution/home and HH/no HH models. The effect of race was modified by insurance and by state. In most instances minorities received less intensive care. PARC use varied by hospital. Conclusions Efforts to further understand the reasons behind these disparities and their effect on outcomes are needed.

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Section: Discussionmentioning

confidence: 99%

Disparities in post-acute rehabilitation care for joint replacement

Freburger¹,

Holmes²,

Ku³

et al. 2011

Arthritis Care Res

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“…The assessment of patient quality of life was completed using the WOMAC questionnaire before surgery and 1 year after surgery [4][5][6]14], specifically for hip and/or knee arthritis. It also was used to assess function in patients with a TKA [20,29,32,34,39]. As with the KSS Ó , the WOMAC is specific to the joint being assessed and does not assess any comorbidity.…”

Section: Quality Of Lifementioning

confidence: 99%

Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?

Utrillas-Compaired

Torre-Escuredo

Tebar-Martínez

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…These pessimistic postoperative expectations may cause a delay in presentation among racial minorities, which could adversely affect outcomes. 25 Examining the physician-patient relationship involves an in-depth evaluation of perceptions and beliefs. Studies have shown that racial disparities may influence the communication, perceptions, and interactions between patients and physicians, as well as instigating bias in the health care setting.…”

Section: Physician-patient Relationshipmentioning

confidence: 99%

“…Although there are few studies that evaluate the differences in postoperative outcomes between ethnic groups, there are some studies that have noted better results in Caucasians. Lavernia et al 25 25 Similarly, a large, retrospective study by Lavernia et al 26 evaluated the role of race and ethnicity in patient-reported functional outcomes following TJA (n=1749 patients). After a mean followup of approximately 5 years (range, 2 to 16 years), they found that African American and Hispanic patients were associated with worse postoperative outcomes, as measured by the Quality of Well-Being (P<.0001), Short Form (SF)-36 physical component (P=.002), WOMAC function (P<.0001), WOMAC pain (P<.0001), and WOMAC stiffness (P<.0001) scores.…”

Section: Patient-reported Outcomesmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15] Furthermore, studies have shown higher complication rates among these ethnic minorities, [16][17][18][19][20][21][22][23][24] and some have even showed an association between disparities and patient-reported and functional outcomes. [25][26][27][28] The following review will highlight more specific details of these disparities and outcome differences.…”

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confidence: 99%

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Racial Disparities in Lower Extremity Arthroplasty Outcomes and Use

et al. 2015

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Race-associated disparities often occur in patients who undergo lower extremity total joint arthroplasty (TJA). Although it is imperative to elucidate and describe the disparities in race and ethnicity that may influence patient perception, satisfaction, and surgical outcomes, there is a paucity of reports detailing the nature of potential racial disparities in TJA. Therefore, the purpose of this review was to examine racial and ethnic disparities in the (1) physician-patient relationship; (2) use of TJA; (3) intraoperative and 30-day postoperative complications; and (4) patient-reported outcomes. Although there are limited studies that evaluated this topic, it has been shown that there are race-specific differences in physician-patient relationships. Specifically, African American patients report lower satisfaction rates in communication with their physician than their Caucasian counterparts and physicians were more apt to describe African Americans as less "medically cooperative." The majority of the studies the authors found regarding TJA use indicated that African Americans and Hispanics were less likely to undergo lower extremity TJA than Caucasians. Furthermore, racial minorities may have higher 30-day readmission and intra- and postoperative complication rates compared with Caucasians. Despite these compelling findings, concrete conclusions are difficult to make due to the presence of multiple confounding patient factors, and more studies examining the racial and ethnic disparities in patients with TJA are needed.

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Fear in Arthroplasty Surgery: The Role of Race

Cited by 13 publications

References 15 publications

Disparities in post-acute rehabilitation care for joint replacement

Disparities in post-acute rehabilitation care for joint replacement

Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?

Racial Disparities in Lower Extremity Arthroplasty Outcomes and Use

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