Scratching the Surface: Itching for Evidence to Reduce Surgical Health Disparities in Total Shoulder Arthroplasty

Liu, Shao‐Hsien; Lapane, Kate L.

doi:10.3899/jrheum.190796

J Rheumatol

2020

DOI: 10.3899/jrheum.190796

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Scratching the Surface: Itching for Evidence to Reduce Surgical Health Disparities in Total Shoulder Arthroplasty

Shao‐Hsien Liu

Kate L. Lapane

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Cited by 5 publications

(1 citation statement)

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“…This disparity has been illustrated thoroughly in studies related to lower extremity total joint arthroplasty (TJA), which report a higher risk of complications and worse functional outcomes in racial and ethnic minority groups when compared with their White counterparts [5][6][7][8][9][10] . Health care disparities are not unique to arthroplasty procedure, as several surgical disciplines have also identified racial and ethnic differences in procedure utilization rates [10][11][12][13][14][15] .…”

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confidence: 99%

Influence of Race on Utilization and Outcomes in Shoulder Arthroplasty

et al. 2023

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Background: Studies have shown that utilization and outcomes after shoulder arthroplasty vary by sociodemographic factors, highlighting disparities in care. This systematic review synthesized all available literature regarding the relationship between utilization and outcomes of shoulder arthroplasty and race/ethnicity. Methods: Studies were identified using PubMed, MEDLINE (through Ovid), and CINAHL databases. All English language studies of Level I through IV evidence that specifically evaluated utilization and/or outcomes of hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty by race and/or ethnicity were included. Outcomes of interest included rates of utilization, readmission, reoperation, revision, and complications.Results: Twenty-eight studies met inclusion criteria. Since the 1990s, Black and Hispanic patients have demonstrated a lower utilization rate of shoulder arthroplasty compared with White patients. Although utilization has increased among all racial groups throughout the present decade, the rate of increase is greater for White patients. These differences persist in both low-volume and high-volume centers and are independent of insurance status. Compared with White patients, Black patients have a longer postoperative length of stay after shoulder arthroplasty, worse preoperative and postoperative range of motion, a higher likelihood of 90-day emergency department visits, and a higher rate of postoperative complications including venous thromboembolism, pulmonary embolism, myocardial infarction, acute renal failure, and sepsis. Patient-reported outcomes, including the American Shoulder and Elbow Surgeon's score, did not differ between Black and White patients. Hispanics had a significantly lower revision risk compared with White patients. One-year mortality did not differ significantly between Asians, Black patients, White patients, and Hispanics. Conclusion:Shoulder arthroplasty utilization and outcomes vary by race and ethnicity. These differences may be partly due to patient factors such as cultural beliefs, preoperative pathology, and access to care, as well as provider factors such as cultural competence and knowledge of health care disparities.

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Influence of Race on Utilization and Outcomes in Shoulder Arthroplasty

et al. 2023

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Disparities in arthroplasty utilization for rotator cuff tear arthropathy

Tornberg¹,

Kleinbart²,

Martin³

et al. 2023

Journal of Shoulder and Elbow Surgery

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A novel comorbidity risk score for predicting postoperative 30-day complications in total shoulder arthroplasty and elucidation of potential racial disparities

Turk¹,

Li²,

Saini³

et al. 2022

JSES International

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Scratching the Surface: Itching for Evidence to Reduce Surgical Health Disparities in Total Shoulder Arthroplasty

Cited by 5 publications

References 22 publications

Influence of Race on Utilization and Outcomes in Shoulder Arthroplasty

Influence of Race on Utilization and Outcomes in Shoulder Arthroplasty

Disparities in arthroplasty utilization for rotator cuff tear arthropathy

A novel comorbidity risk score for predicting postoperative 30-day complications in total shoulder arthroplasty and elucidation of potential racial disparities

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