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

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).

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.

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.

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.