Racial/Ethnic and Socioeconomic Disparities in Total Knee Arthroplasty 30- and 90-Day Readmissions: A Multi-Payer and Multistate Analysis, 2007–2014

Arroyo, Noelle S.; White, Robert S.; Gaber-Baylis, Licia K.; La, Melvin; Fisher, Andrew D; Samaru, Mahendranauth

doi:10.1089/pop.2018.0025

Cited by 53 publications

(41 citation statements)

References 30 publications

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“…Consistent with a growing body of literature showing that black race is a risk factor for poor outcomes after TJR [27][28][29][30][31][32], black race was a significant independent predictor of risk of complications after TJR in the present study. Potential modifiers of racial disparities in TJR outcomes include socioeconomic status and access to health care [28,31].…”

Section: Discussionsupporting

confidence: 90%

The Impact of Hepatitis C and Liver Disease on Risk of Complications After Total Hip and Knee Arthroplasty: Analysis of Administrative Data From Louisiana and Texas

et al. 2021

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Background: Millions of Americans have hepatitis C and other liver diseases, many of whom have endstage osteoarthritis requiring total joint arthroplasty (TJA). This study aimed to determine the extent to which hepatitis C and other liver diseases are independent risk factors for complications, including readmission and reoperation, in patients undergoing TJA. Methods: Retrospective study of a REACHnet data set containing demographics, International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes, and clinical and laboratory data for patients who underwent primary total knee or hip replacement from 2013 to 2017 at 3 hospital systems in Louisiana and Texas. Multivariable logistic regression analyses examined predictors of complications. Any complication was defined as a 90-day medical complication or readmission or reoperation within 1 year. Results: Among 13,673 patients who met inclusion criteria, 14.9% (2044/13,673) had any complication, 11.7% (1600/13,673) were readmitted within 90 days, and 3.6% (497/13,673) had a reoperation within 1 year. Liver disease increased the odds for any complication (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.18), 90-day medical complication (OR, 1.13; 95% CI, 1.04-1.22), and 90-day readmission (OR, 1.11; 95% CI, 1.06-1.17). Hepatitis C was not, by itself, associated with an increase in any type of complication but was usually associated with liver disease. Comorbidity severity was the strongest predictor of all types of complications after TJA. Conclusion: Patients in Louisiana and Texas with liver disease were at increased risk for complications after TJA, corroborating findings of previous studies. Hepatitis C was not an independent predictor of complications because of its high association with liver disease.

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Section: Discussionsupporting

confidence: 90%

The Impact of Hepatitis C and Liver Disease on Risk of Complications After Total Hip and Knee Arthroplasty: Analysis of Administrative Data From Louisiana and Texas

et al. 2021

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“…17 Multiple studies have attempted to address these disparities and have analyzed universally insured databases, private payer systems, and conducted a multistate analysis to observe trends in TJA by race and other socioeconomic factors. 7,9,10,17,21,23,39 Okike et al 23 studied the effect of race and ethnicity in patients set to undergo THA in the universally insured healthcare model of Kaiser Permanente. 23 Their study demonstrated that African-Americans and other non-Caucasians have similar or better outcomes than their Caucasian counterparts under this system.…”

Section: Discussionmentioning

confidence: 99%

Does racial background influence outcomes following total joint arthroplasty?

Singh

Realyvasquez

Kugelman

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: The purpose of this study is to assess whether racial differences influence patient-reported outcome measures (PROMs) following primary total hip (THA) and knee (TKA) arthroplasty. Methods: We retrospectively reviewed patients who underwent primary THA or TKA from 2016 to 2020 with available PROMs. Both THA and TKA patients were separated into three groups based on their ethnicity: Caucasian, African-American, and other races. Patient demographics, clinical data, and PROMs at various time-periods were collected and compared. Demographic differences were assessed using chisquare and ANOVA. Univariate ANCOVA was utilized to compare outcomes and PROMs while accounting for demographic differences. Results: This study included 1999 THA patients and 1375 TKA patients. In the THA cohort, 1636 (82%) were Caucasian, 177 (9%) were African-American, and 186 (9%) were of other races. In the TKA cohort, 864 (63%) were Caucasian, 236 (17%) were African-American, and 275 (20%) were of other races. Surgicaltime significantly differed between the groups that underwent THA (88.4vs.100.5vs.96.1; p < 0.001) with African-Americans requiring the longest operative time. Length-of-stay significantly differed in both THA (1.5vs.1.9vs.1.8; p < 0.001) and TKA (2.1vs.2.5vs.2.3; p < 0.001) cohorts, with African-Americans having the longest stay. Caucasians reported significantly higher PROM scores compared to non-Caucasians in both cohorts. All-cause emergency-department (ED) visits, 90-day postoperative events (read-missions&revisions), and discharge-disposition did not statistically differ in both cohorts. Conclusion: Non-Caucasian patients demonstrated lower PROM scores when compared to Caucasian patients following TJA although the differences may not be clinically relevant. LOS was significantly longer for African-Americans in both THA and TKA cohorts. Further investigation identifying racial disparity interventions is warranted.

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“…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%

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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Racial/Ethnic and Socioeconomic Disparities in Total Knee Arthroplasty 30- and 90-Day Readmissions: A Multi-Payer and Multistate Analysis, 2007–2014

Cited by 53 publications

References 30 publications

The Impact of Hepatitis C and Liver Disease on Risk of Complications After Total Hip and Knee Arthroplasty: Analysis of Administrative Data From Louisiana and Texas

The Impact of Hepatitis C and Liver Disease on Risk of Complications After Total Hip and Knee Arthroplasty: Analysis of Administrative Data From Louisiana and Texas

Does racial background influence outcomes following total joint arthroplasty?

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

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