Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Abstract

Introduction The literature has consistently demonstrated utilization disparities in joint replacement procedures, though no studies have evaluated disparities in total shoulder arthroplasty with regard to operative volume. Methods We queried the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database for 32 410 total shoulder arthroplasties performed between 2009 and 2017. Patients were identified using Clinical Classifications Software code 154 for Non-Hip/Knee Arthroplasty and All Patient Refined-Diagnosis Related Group code 322 for Shoulder. Racial groups included Hispanic, non-Hispanic white, non-Hispanic black, and Other. High-volume centers were facilities that performed 2 standard deviations above the mean annual procedures. Utilization rates were calculated by dividing total shoulder arthroplasties per group by the 2010 NY Census population of that group. The Fisher exact test was used to determine significance. Results Total shoulder arthroplasty utilization increased from 43/100 000 to 73/100 000, two-thirds of which was driven by an increase in white resident utilization. More White residents per 100 000 underwent shoulder arthroplasty than Black, Hispanic, and Other residents per 100 000 residents of their respective race. White residents were 90% more likely than Hispanic residents to undergo total shoulder arthroplasty at high-volume centers ( P = .04). There were no differences in utilization rate regarding operative volume comparing Black or Other residents to White residents. More females underwent total shoulder arthroplasty than males, though there was no difference in utilization rate regarding operative volume. Conclusion Though total shoulder arthroplasty utilization nearly doubled, disparities persisted across gender and minority groups particularly in Hispanic utilization as White residents were 90% more likely than Hispanic residents to undergo shoulder arthroplasty at high-volume centers.

Anterosuperior versus deltopectoral approach for primary reverse total shoulder arthroplasty

“…32 Patient demographic characteristics may also differ between high- and low-volume centres. 33,34 Our results also show that different prosthetic designs and sizes are preferred by surgeons using one of both approaches. Centre volume was a confounding factor in one of three regression analyses, and the implant selected in all three regression analyses.…”

Influence of Race on Utilization and Outcomes in Shoulder Arthroplasty

“…Of the 30 studies, 9 compared shoulder arthroplasty utilization and outcomes between at least 4 racial and/or ethnic groups (White, Black, Asian, and Hispanic) 1,2,26-32 , 10 compared between 3 racial groups 33-42 , and 11 compared between 2 racial groups 44-53 . Twenty-eight studies directly compared White and Black patients.…”

“…Current literature suggests that longer LOS in Black patients may be due to higher rates of complications, increased preexisting comorbidities, and decreased social support, but more research is needed to identify specific factors 48,50,54 . There is also evidence for decreased surgical complications and mortality rates at high-volume centers compared with low-volume medical centers 40,64,65 . Because White patients may be more likely to undergo shoulder arthroplasty at a high-volume center, this is a possible explanation for decreased complications and LOS for White patients 53 .…”

“…Zmistowski et al 53 reported that White Medicare patients are independent predictors of increased TSA use within a given hospital referral region. In addition, Markes et al 40 found racial disparity in the incidence of TSA within both lowvolume and high-volume centers, reporting that White patients were 90% more likely than Hispanics to undergo TSA at a high-volume center. 45 .…”

“…Of the 30 studies, 9 compared shoulder arthroplasty utilization and outcomes between at least 4 racial and/or ethnic groups (White, Black, Asian, and Hispanic) 1,2,[26][27][28][29][30][31][32] , 10 compared between 3 racial groups [33][34][35][36][37][38][39][40][41][42] , and 11 compared between 2 racial groups [44][45][46][47][48][49][50][51][52][53]…”