What Factors Lead to Racial Disparities in Outcomes After Total Knee Arthroplasty?

Hu, Daniel A.; Hu, James B.; Lee, Ariel; Rubenstein, William J.; Hwang, Kathleen; Ibrahim, Said A.; Kuo, Alfred C.

doi:10.1007/s40615-021-01168-4

Cited by 26 publications

(13 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…30 Issues of health disparity are multifaceted; and individual, health care, and societal factors may all contribute to worse outcomes in Black patients. 32 Early adverse events were associated with worse PROMIS 10 MH scores at 1 year postoperatively, which demonstrates that physical setbacks early in rehabilitation can have lasting mental effects in patients. Further work exploring and calculating MIDs within subgroups of patients that may differ could improve the delivery and interpretation of treatments for all patients.…”

Section: Discussionmentioning

confidence: 92%

Establishing the Minimally Important Difference for the KOOS–Joint Replacement and PROMIS Global–10 in Patients After Total Knee Arthroplasty

Spiering,

Firth,

Mousoulis

et al. 2024

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Despite the overall prevalence and success of total knee arthroplasty (TKA), a significant portion of patients are dissatisfied with their outcomes. Purpose: To assess the responsiveness and determine the minimally important difference (MID) of 2 patient-reported outcome measures (PROMs)—the Knee injury and Osteoarthritis Outcome Score–Joint Replacement (KOOS-JR) and the Patient-Reported Outcomes Measurement Information System Global–10 (PROMIS 10)—in patients after TKA. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients who underwent TKA from August 2015 through August 2019 and completed baseline and postoperative KOOS-JR and PROMIS 10 surveys. The PROMIS 10 consists of 2 domains: physical health and mental health. Estimates for the reliable change index (RCI) and MID, using anchor-based and distribution-based methods, were calculated for each PROM. Regression modeling was used to determine whether patient and clinical factors predicted MID thresholds or MID achievement. Results: A total of 1315 patients were included. Distribution-based MIDs, calculated using various methods from baseline scores, ranged from 19.3 to 31 for the KOOS-JR, and the RCI was 4.38. Of these patients, 293 (22.3%) demonstrated small or moderate improvement, and this cohort was included in the calculation of anchor-based MIDs. The anchor-based MIDs were 16.9 and 24.3 at 3-month and 1-year follow-up, respectively, and 66% of patients achieved the MID at 12 months. Higher preoperative PROM score, male sex, non-White race, and current smoker status were predictive of failing to achieve the anchor-based MID for KOOS-JR at 1 year postoperatively ( P < .05). Higher preoperative PROM score and any 90-day adverse event predicted lower thresholds of important change in anchor-based MIDs. Higher baseline PROM scores, younger age, male sex, non-White ethnicity, higher American Society of Anesthesiologists classification, preoperative narcotics use, not smoking, and longer hospital stay were all associated with lower odds of achieving the MID on the KOOS-JR or either of the PROMIS 10 subscales. Conclusion: The study results demonstrated relevant values for interpretation of the KOOS-JR and PROMIS 10. While patient demographics did not accurately predict which patients would achieve the MID, some potential factors predicting successful patient-reported outcomes after TKA were identified.

show abstract

Section: Discussionmentioning

confidence: 92%

Establishing the Minimally Important Difference for the KOOS–Joint Replacement and PROMIS Global–10 in Patients After Total Knee Arthroplasty

Spiering,

Firth,

Mousoulis

et al. 2024

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…Prior studies in various medical and surgical subspecialties have analyzed the relationships among race, ethnicity, and sociodemographic factors in the context of health outcomes 1,21,[37][38][39][40][41][42] . Findings regarding which factors predominantly affect score variation have differed throughout the orthopaedic literature.…”

Section: Discussionmentioning

confidence: 99%

“…Recent research has focused on understanding social determinants of health that influence PROM scores, both in response to treatment 8,14-16,18 and at initial presentation 17,19-23 . Prior studies investigating baseline PROMs across U.S. orthopaedic populations found that Black, Hispanic, non-English-speaking, less-educated, and lower-income patients had worse outcomes 15,24-27 .…”

mentioning

confidence: 99%

The Effects of Sociodemographic Factors on Baseline Patient-Reported Outcome Measures in Patients with Foot and Ankle Conditions

Boakye

Parker

Chiodo

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Racial and ethnic care disparities persist within orthopaedics in the United States. This study aimed to deepen our understanding of which sociodemographic factors most impact patient-reported outcome measure (PROM) score variation and may explain racial and ethnic disparities in PROM scores.Methods: We retrospectively reviewed baseline PROMIS (Patient-Reported Outcomes Measurement Information System) Global-Physical (PGP) and PROMIS Global-Mental (PGM) scores of 23,171 foot and ankle patients who completed the instrument from 2016 to 2021. A series of regression models was used to evaluate scores by race and ethnicity after adjusting in a stepwise fashion for household income, education level, primary language, Charlson Comorbidity Index (CCI), sex, and age. Full models were utilized to compare independent effects of predictors.Results: For the PGP and PGM, adjusting for income, education level, and CCI reduced racial disparity by 61% and 54%, respectively, and adjusting for education level, language, and income reduced ethnic disparity by 67% and 65%, respectively. Full models revealed that an education level of high school or less and a severe CCI had the largest negative effects on scores.Conclusions: Education level, primary language, income, and CCI explained the majority (but not all) of the racial and ethnic disparities in our cohort. Among the explored factors, education level and CCI were predominant drivers of PROM score variation.

show abstract

“…Leadership in orthopaedics at the national and regional level remains deficient in terms of Black faces [3]. Black patients continue to experience unnecessary and preventable complications, poorer access to care, and discrimination when they do encounter a provider [1,4].…”

mentioning

confidence: 99%

The Forward Movement: Sustaining Progress in Reversing Racial Inequities

Owusu-Akyaw

2022

Clin Orthop Relat Res

View full text Add to dashboard Cite

What Factors Lead to Racial Disparities in Outcomes After Total Knee Arthroplasty?

Cited by 26 publications

References 45 publications

Establishing the Minimally Important Difference for the KOOS–Joint Replacement and PROMIS Global–10 in Patients After Total Knee Arthroplasty

Establishing the Minimally Important Difference for the KOOS–Joint Replacement and PROMIS Global–10 in Patients After Total Knee Arthroplasty

The Effects of Sociodemographic Factors on Baseline Patient-Reported Outcome Measures in Patients with Foot and Ankle Conditions

The Forward Movement: Sustaining Progress in Reversing Racial Inequities

Contact Info

Product

Resources

About