The Association of Race/Ethnicity and Total Knee Arthroplasty Outcomes in a Universally Insured Population

Hinman, Adrian D.; Chan, Priscilla H.; Prentice, Heather A.; Paxton, Elizabeth W.; Okike, Kanu; Navarro, Ronald A.

doi:10.1016/j.arth.2020.02.002

Cited by 70 publications

(51 citation statements)

References 52 publications

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“…In fact, the risk of postoperative morbidity or mortality was between 0.5% and 1.0% higher for African Americans and Hispanics at all hematocrits. Other races, which was mostly composed of Asians, had the lowest risk of postoperative morbidity or mortality, which is consistent with a prior study where Asians had a low risk of postoperative complications after knee arthroplasty 30 …”

Section: Discussionsupporting

confidence: 91%

“…Other races, which was mostly composed of Asians, had the lowest risk of postoperative morbidity or mortality, which is consistent with a prior study where Asians had a low risk of postoperative complications after knee arthroplasty. 30 Our study has several limitations. First, our data came from NSQIP, which represents a specific sample of hospitals and may not be representative of all hospitals in the Unites States.…”

Section: Discussionmentioning

confidence: 91%

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Anemia, sex, and race as predictors of morbidity or mortality after knee arthroplasty surgery

et al. 2020

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Background: Anemia is associated with poor outcome after major joint replacement surgery, but it is unclear whether sex and race modify its impact on outcome. We hypothesized that anemia would be associated with increased morbidity or mortality after knee arthroplasty surgery and that sex and race would be effect modifiers for this relationship. Study Design and Methods: We performed a retrospective cohort study of elective knee arthroplasty patients between 2013 and 2018 using data from the National Surgical Quality Improvement Program. Morbidity or mortality after surgery was compared between patients without anemia, with mild anemia, and with moderate to severe anemia. Multivariable logistic regression was used to determine adjusted odds for morbidity or mortality with anemia. Interaction terms were entered into the model to test for effect modification by sex and race. Results: 243 491 patients were included and 30 135 patients (12.4%) were anemic. Morbidity or mortality occurred in 3.7% of patients without anemia, 5.2% of patients with mild anemia, and 7.1% of patients with moderate to severe anemia (P < .001). After adjustment for confounding variables, mild anemia OR = 1.36 (95% CI = 1.28-1.45), and moderate to severe anemia OR = 1.92 (95% CI = 1.72-2.13) were associated with increased odds of morbidity or mortality. Sex, but not race, was a significant effect modifier with men having a greater increase in morbidity or mortality when anemic (P = .02). Conclusions: Anemia is associated with increased morbidity or mortality after knee arthroplasty surgery and men have a greater increase in perioperative risk than women when anemic.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Anemia, sex, and race as predictors of morbidity or mortality after knee arthroplasty surgery

et al. 2020

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“… 28 A recent study analyzing TKR outcomes in patients enrolled in a single integrated health maintenance organization also found a high risk of aseptic revision TKR in Black patients despite identical insurance coverage in all participants. 20 That study supports the concept that there are unmeasured factors associated with revision TKR risk in Black patients.…”

Section: Discussionsupporting

confidence: 79%

“…Although few studies have analyzed septic and aseptic revision TKR separately, 17 , 18 , 19 , 20 these 2 outcomes represent very different mechanisms of TKR failure. Given this fact, we herein hypothesize that racial disparities in revision TKR risk will vary depending on the indication for revision (septic vs aseptic).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Racial Disparities in the Risks of Septic and Aseptic Revision Total Knee Replacements

et al. 2021

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IMPORTANCE Black patients are at higher risk of revision total knee replacement (TKR) than White patients, but whether racial disparities exist for both septic and aseptic revision TKR and the reason for any disparities are unknown.OBJECTIVE To assess the risk of septic and aseptic revision TKR in Black and White patients and to examine interactions among race and socioeconomic and hospital-related variables that are associated with revision TKR risk.

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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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The Association of Race/Ethnicity and Total Knee Arthroplasty Outcomes in a Universally Insured Population

Cited by 70 publications

References 52 publications

Anemia, sex, and race as predictors of morbidity or mortality after knee arthroplasty surgery

Anemia, sex, and race as predictors of morbidity or mortality after knee arthroplasty surgery

Assessment of Racial Disparities in the Risks of Septic and Aseptic Revision Total Knee Replacements

Does racial background influence outcomes following total joint arthroplasty?

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