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Outpatient Total Joint Arthroplasty: Are We Closing the Racial Disparities Gap?
Hristo Piponov1, Blake Acquarulo2, Andre Ferreira3
1Department of Orthopaedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX, 77030, USA.
Journal of Racial and Ethnic Health Disparities
|September 13, 2022
Summary
Outpatient joint replacement surgery is more common in non-White patients. While complications are similar, outpatient knee replacements show higher readmission rates, potentially widening health disparities.
Area of Science:
- Orthopedic Surgery
- Health Disparities Research
- Health Services Research
Background:
- Total joint arthroplasty (TJA) is increasingly shifting to outpatient settings.
- The impact of this trend on health disparities requires investigation.
Purpose of the Study:
- To examine racial/ethnic disparities in outpatient TJA rates.
- To assess the effect of outpatient surgery on 30-day complication and readmission rates across different racial/ethnic groups.
Main Methods:
- Retrospective review of the ACS National Surgical Quality Improvement Program (2011-2018).
- Analysis of primary, elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- Comparison of outpatient vs. inpatient procedures and outcomes across racial/ethnic groups, adjusting for covariates.
Main Results:
- Non-White patients, including African American, Hispanic, and Asian individuals, showed a higher likelihood of undergoing outpatient THA and TKA compared to White patients.
- Outpatient surgery did not increase complication rates across any group.
- Outpatient TKA was associated with significantly higher readmission rates for all non-White groups compared to inpatient TKA.
Conclusions:
- Most non-White racial/ethnic groups have a higher proportion of outpatient TJAs.
- Increased readmission rates for outpatient TKA in these groups may exacerbate existing health disparities.
