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Is There an Implicit Racial Bias in the Case Order of Elective Total Joint Arthroplasty?

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Abstract

Introduction

Identifying ways to improve equitable access to healthcare is of the utmost important. In this study, we analyzed whether patient race was negatively associated with surgical start times for total joint arthroplasties (TJA).

Methods

The surgical case order and start times of all primary TJAs performed at a large academic medical center between May 2014 and May 2018 were retrospectively reviewed. Patients were included if > 21, had a documented self-reported race, and were operated on by an arthroplasty fellowship-trained surgeon. Operations were categorized as first-start, early (7:00 AM–11:00 AM), mid-day (11:00 AM–3:00 PM), or late (after 3:00 PM). Multivariable logistic regression (MLR) was performed, and odds ratios (OR) were calculated.

Results

This study identified 1663 TJAs—871 total knee (TKA) and 792 total hip arthroplasties (THA) who met inclusion criteria. Overall, there was no association between race and surgical start time. Upon sub-analysis by surgical type, this held true for TKA patients, but self-identifying Hispanic and non-Hispanic Black patients undergoing THA were more likely to have later surgical start times (ORs: 2.08 and 1.88; p < 0.05).

Discussion

Although there was no association between race and overall TJA surgical start times, patients with marginalized racial and ethnic identities were more likely to undergo elective THA later in the surgical day. Surgeons should be aware of potential implicit bias when determining case order to potentially prevent adverse outcomes due to staff fatigue or lack of proper resources later in the day.

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Data Availability

All data remain available at the Center for Hip and Knee Research at Columbia University Irving Medical Center.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, 622 W. 168th, PH-1110032, USA

    Austin C. Kaidi, Bradley T. Hammoor, Wakenda K. Tyler, Jeffrey A. Geller & H. John Cooper

  2. Department of Orthopaedic Surgery, Yale University, 260 Long Ridge Rd, CT, Stamford, United States

    Thomas R. Hickernell

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Austin Kaidi and Bradley Hammoor. The first draft of the manuscript was completed by Austin Kaidi, and all authors have read, edited, and approved the final manuscript.

Corresponding author

Correspondence to Thomas R. Hickernell.

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Ethics Approval

This study was performed with permission from our institution’s Institutional Review Board.

Competing Interests

Authors Austin Kaidi and Bradley Hammoor have no financial interests to disclose. Wakenda Tyler has served as a paid consultant for Johnson & Johnson and Stryker, an unpaid consultant for the Musculoskeletal Transplant Foundation, and is a board member of the American Association of Orthopedic Surgeons, J. Robert Gladden Society, Journal of the American Academy of Orthopedic Surgeons, and Muskuloskeletal Tumor Society. Jeffrey Geller has served as a paid consultant for Nimble Health and Smith & Nephew, receives research support from the Orthopaedic Scientific Research Foundation, and is on the board of Clinical Orthopaedics and Related Research, the Journal of Arthroplasty, and the Journal of Bone and Joint Surgery – British. H. John Cooper has served as a paid consultant for DePuy, a Johnson & Johnson Company, KCI UA, KCI Medical Canada, and Zimmer-Biomet, has received research support from KCI, and is on the board of the American Association of Orthopedic Surgeons and the Journal of Bone and Joint Surgery. Thomas Hickernell serves on the board of the New York State Society of Orthopedic Surgeons.

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Kaidi, A.C., Hammoor, B.T., Tyler, W.K. et al. Is There an Implicit Racial Bias in the Case Order of Elective Total Joint Arthroplasty?. J. Racial and Ethnic Health Disparities 11, 1–6 (2024). https://doi.org/10.1007/s40615-022-01492-3

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