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Total Hip Arthroplasty in Black/African American Patients: an Updated Nationwide Analysis

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Abstract

Background

The purpose of this was to investigate recent trends in procedure utilization, comorbidity profiles, hospital length of stay (LOS), 30-day outcomes, and risk factors for adverse events (AEs) among Black patients undergoing total hip arthroplasty (THA).

Methods

Using the American College of Surgeons National Surgery Quality Improvement Program, we retrospectively reviewed all Black patients who underwent elective, primary THA between 2011 and 2017. Mixed effects logistic regression analyses were performed to determine the trends in the study outcomes across each individual year. Multivariate logistic regression analyses were performed to identify independent risk factors for AEs.

Results

A total of 11,574 Black patients were analyzed. Over the study period, there was an increase by 109% in THA procedures performed in this racial group. During the same time, there were reductions in the prevalence of anemia, dyspnea, tobacco smoking, and osteonecrosis (p < 0.001). The rates of 30-day surgical complications, readmissions, reoperations, and mortality remained unchanged. Only the rate of medical complications demonstrated improvement, driven by a decrease in the incidence of postoperative myocardial infarction (p < 0.001). There was also a significant reduction in LOS > 2 days (68 to 37%, p < 0.001). Independent risk factors for AEs were body mass index > 35, American Society of Anesthesiologists score > 2, dependent functional status, diabetes, bleeding disorders, chronic kidney disease, and osteonecrosis as the surgical indication.

Conclusion

Between 2011 and 2017, there were improving trends in procedure utilization, comorbidity profiles, and LOS among Black patients undergoing primary THA, but the overall rates of 30-day outcomes remained unchanged. We identified a number of risk factors that may help guide preoperative optimization and patient counseling to mitigate postoperative AEs.

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References

  1. Pérez-Stable E. At NIH, Minority health is everyone’s concern, every day. National Institute of Arthritis and Musculoskeletal and Skin Diseases Available at: https://www.niams.nih.gov/about/about-the-director/letter/nih-minority-health-everyones-concern-every-day. Last accessed April 21, 2020.

  2. Rowley DL, Jenkins BC, Frazier E. Utilization of joint arthroplasty: racial and ethnic disparities in the Veterans Affairs Health Care System. J Am Acad Orthop Surg. 2007;15(Suppl 1):S43–8.

    Article  Google Scholar 

  3. Zhang W, Lyman S, Boutin-Foster C, Parks ML, Pan TJ, Lan A, et al. Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Joint Surg Am. 2016;98(15):1243–52.

    Article  Google Scholar 

  4. Singh JA, Lu X, Rosenthal GE, Ibrahim S, Cram P. Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data. Ann Rheum Dis. 2014;73(12):2107–15.

    Article  Google Scholar 

  5. Goodman SM, Mandl LA, Parks ML, Zhang M, McHugh KR, Lee YY, et al. Disparities in TKA outcomes: census tract data show interactions between race and poverty. Clin Orthop Relat Res. 2016;474(9):1986–95.

    Article  Google Scholar 

  6. Goodman SM, Mehta B, Zhang M, Szymonifka J, Nguyen JT, Lee L, et al. Disparities in total hip arthroplasty outcomes: census tract data show interactions between race and community deprivation. J Am Acad Orthop Surg. 2018;26(21):e457–64.

    Article  Google Scholar 

  7. Lavernia CJ, Villa JM. Does race affect outcomes in total joint arthroplasty? Clin Orthop Relat Res. 2015;473(11):3535–41.

    Article  Google Scholar 

  8. Allen Butler R, Rosenzweig S, Myers L, Barrack RL. The Frank Stinchfield Award: the impact of socioeconomic factors on outcome after THA: a prospective, randomized study. Clin Orthop Relat Res. 2011;469(2):339–47.

    Article  CAS  Google Scholar 

  9. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5.

    Article  Google Scholar 

  10. Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am. 2014;96(8):624–30.

    Article  Google Scholar 

  11. Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21.

    Article  Google Scholar 

  12. McMorrow S, Long SK, Kenney GM, Anderson N. Uninsurance disparities have narrowed for Black and Hispanic adults under the Affordable Care Act. Health Aff (Millwood). 2015;34(10):1774–8.

    Article  Google Scholar 

  13. The American College of Surgeons National Surgical Quality Improvement Program. Frequently asked questions. Available at: https://www.facs.org/quality-programs/acs-nsqip/faq. Last accessed on July 14, 2020.

  14. Aseltine RH Jr, Wang W, Benthien RA, Katz M, Wagner C, Yan J, et al. Reductions in race and ethnic disparities in hospital readmissions following total joint arthroplasty from 2005 to 2015. J Bone Joint Surg Am. 2019;101(22):2044–50.

    Article  Google Scholar 

  15. Kapadia BH, Issa K, Pivec R, Bonutti PM, Mont MA. Tobacco use may be associated with increased revision and complication rates following total hip arthroplasty. J Arthroplast. 2014;29(4):777–80.

    Article  Google Scholar 

  16. United States Census Bureau. Race: American Community Survey. Available at: https://data.census.gov/cedsci/all?q=Race%20and%20Ethnicity&tid=ACSDT1Y2018.B02001&vintage=2018&hidePreview=false. Last accessed on Mary 7, 2020.

  17. Foley B, Cleveland RJ, Renner JB, Jordan JM, Nelson AE. Racial differences in associations between baseline patterns of radiographic osteoarthritis and multiple definitions of progression of hip osteoarthritis: the Johnston County Osteoarthritis Project. Arthritis Res Ther. 2015;17:366.

    Article  Google Scholar 

  18. Ghomrawi HMK, Funk RJ, Parks ML, Owen-Smith J, Hollingsworth JM. Physician referral patterns and racial disparities in total hip replacement: a network analysis approach. PLoS One. 2018;13(2):e0193014.

    Article  Google Scholar 

  19. Halbert CH, Armstrong K, Gandy OH Jr, Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166(8):896–901.

    Article  Google Scholar 

  20. Santaguida PL, Hawker GA, Hudak PL, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51(6):428–36.

    PubMed  PubMed Central  Google Scholar 

  21. Allen KD, Golightly YM, Callahan LF, Helmick CG, Ibrahim SA, Kwoh CK, et al. Race and sex differences in willingness to undergo total joint replacement: the Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken). 2014;66(8):1193–202.

    Article  Google Scholar 

  22. Katz JN. Persistence of racial and ethnic differences in utilization and adverse outcomes of total joint replacement. J Bone Joint Surg Am. 2016;98(15):1241–2.

    Article  Google Scholar 

  23. Tamayo-Sarver JH, Hinze SW, Cydulka RK, Baker DW. Racial and ethnic disparities in emergency department analgesic prescription. Am J Public Health. 2003;93(12):2067–73.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX, 77030, USA

    Mihir Sheth, Monique Chambers, Melvyn A. Harrington & Mohamad J. Halawi

  2. University of Connecticut School of Medicine, Farmington, CT, USA

    Christian Gronbeck

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  1. Mihir Sheth
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  2. Monique Chambers
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  3. Christian Gronbeck
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  4. Melvyn A. Harrington
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  5. Mohamad J. Halawi
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Correspondence to Mohamad J. Halawi.

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Sheth, M., Chambers, M., Gronbeck, C. et al. Total Hip Arthroplasty in Black/African American Patients: an Updated Nationwide Analysis. J. Racial and Ethnic Health Disparities 8, 698–703 (2021). https://doi.org/10.1007/s40615-020-00829-0

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  • DOI: https://doi.org/10.1007/s40615-020-00829-0

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