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Disparities in the utilization of high-volume hospitals for total hip replacement
Nelson F SooHoo1, Eugene Farng, David S Zingmond
1Department of Orthopaedic Surgery, University of California Los Angeles, 10945 Le Conte Ave., PVUB #3355, Los Angeles, CA 90095, USA. nsoohoo@mednet.ucla.edu
Insights
Racial and ethnic disparities exist in total-hip replacement care. Minority patients, including Hispanic, Black, and Asian individuals, are more likely to receive care at lower-volume hospitals.
Area of Science:
- Orthopedic surgery
- Health services research
Background:
- Higher hospital surgical volumes correlate with reduced complication rates in total-hip replacement (THR).
- Understanding patient characteristics at high-volume vs. low-volume THR centers is crucial for equitable care.
Purpose of the Study:
- To identify patient demographics undergoing THR at high-volume hospitals.
- To compare these patients with those treated at low-volume hospitals.
Main Methods:
- Analysis of California discharge data (1995-2005) for primary total-hip replacements.
- Hospitals categorized into low, intermediate, and high surgical volume tiers.
- Logistic regression models assessed race/ethnicity and income in relation to hospital volume, controlling for age, gender, and comorbidity.
Main Results:
- 138,399 primary total-hip replacements were analyzed.
- Hispanic, Black, and Asian patients exhibited higher relative risk ratios for treatment at low-volume centers compared to White patients.
Conclusions:
- Significant disparities exist in patient populations at high-volume versus low-volume THR hospitals.
- Hispanic ethnicity, Black race, and Asian race are statistically significant predictors for receiving care at low-volume facilities.
Objective:
Higher hospital surgical volumes have been associated with lower complication rates following total-hip replacement. The objective of this study was to identify the characteristics of patients who undergo total-hip replacement at high-volume hospitals and their differences from those who receive care at low-volume hospitals.
Methods:
Discharge data from patients undergoing total hip replacement in California from 1995 to 2005 were analyzed. Hospitals were classified into 3 tiers of low, intermediate, or high surgical volume. The relationships between race/ethnicity and income to utilization of low-volume and high-volume hospitals were examined by creating logistic regression models that include patient covariates such as age, gender, and comorbidity.
Results:
This study analyzed 138399 cases of primary total-hip replacements during the study period. Patients of Hispanic ethnicity, or black or Asian race had higher relative risk ratios for being treated at a low-volume center compared to white patients.
Conclusions:
There are disparities in the characteristics of patients receiving care at hospitals performing a high volume or low volume of total-hip replacements. Hispanic ethnicity, and black and Asian race were statistically significant predictors of utilization of a low-volume hospital.
