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Complications and Costs Associated With Ethnicity Following Total Hip Arthroplasty: A Retrospective Matched Cohort
Vikram A Aggarwal1, Garrett Sohn1, Sharon Walton1
1Orthopedics, University of Texas Southwestern Medical Center, Dallas, USA.
Insights
Black patients face more complications and higher costs after total hip arthroplasty (THA). While Asian and Hispanic patients had higher costs, their complication rates were similar to White patients, indicating a need for equitable healthcare.
Area of Science:
- Orthopedic Surgery
- Health Disparities Research
- Health Economics
Background:
- Minority patients often experience increased complications, revisions, and costs post-total hip arthroplasty (THA).
- Existing research highlights potential racial disparities in THA outcomes.
- This study examines the correlation between race and THA complications, revisions, and costs.
Purpose of the Study:
- To investigate racial disparities in surgical complications, revision rates, and total costs following THA.
- To compare outcomes across White, Black, Asian, and Hispanic THA patients.
- To analyze these disparities before and after propensity matching.
Main Methods:
- Utilized data from 2014-2016 from a commercial insurance database (PearlDiver).
- Included THA patients identified by CPT-27130 and ICD-9-P-8151 codes.
- Compared White, Black, Asian, and Hispanic patients on demographics, comorbidities, length of stay, complications, and costs, using unequal variance t-tests before and after matching for key variables.
Main Results:
- Included 73,688 White, 4,822 Black, 268 Asian, and 420 Hispanic patients.
- Minority patients, particularly Black patients, had higher complication rates and costs.
- After matching, Black and Hispanic patients still showed higher comorbidity indices and lengths of stay, with Black patients having decreased revision rates but Black, Hispanic, and Asian patients incurring higher costs.
Conclusions:
- Black patients face significantly higher complication rates and total costs after THA.
- Asian and Hispanic patients showed no significant difference in complications but higher costs.
- Findings support reducing health disparities for Black patients post-THA, but further research is needed for Asian and Hispanic patient outcomes due to small sample sizes.
Background:
Minority patients often have greater numbers of complications, revisions, and costs after total hip arthroplasty (THA). This study investigates how race correlates with specific surgical complications, revisions, and total costs following THA both before and after propensity matching.
Methods:
Data from 2014-2016 were collected from a large commercial insurance database known as PearlDiver. THA patients were assigned under Current Procedural Terminology (CPT-27130) and International Statistical Classification of Diseases (ICD-9-P-8151) codes and then divided into groups based on racial status in the database. Patients of different ethnicities including White, Black, Asian, and Hispanic patients were compared in regard to age, gender, comorbidities, lengths of stay, and surgical complications and costs at thirty days, ninety days, and one year using unequal variance t-tests. Black, Asian, and Hispanic patients are collectively referred to as minority patients. Patient comparisons were done both before and after matching for age, gender, tobacco use, diabetes, and obesity comorbidities.
Results:
A total of 73,688 White (93%), 4,822 Black (6%), 268 Asian (0.3%), and 420 Hispanic (0.5%) THA patients were included. Significantly more minority patients underwent THA under the age of 65 and had higher comorbidity indices and lengths of stay. Black patients had significantly higher complication rates, but there was no significant difference in rates of revision in any minority group. Minority patients were charged 9%-83% more. After matching, Black and Hispanic patients maintained higher comorbidity indices and lengths of stay. Black patients had a spectrum of complication rates but significantly decreased revision rates. Furthermore, after matching, minority patients were charged 5%-65% more.
Conclusions:
Black patients experienced significantly greater rates of complications and higher total costs; whereas, Asian and Hispanic patients did not have significant differences in complications but did have higher costs. Therefore, this study aligns with previous studies and supports our hypothesis that Black ethnicity patients have worse outcomes than White ethnicity patients after THA, advocating for reducing health disparities and establishing more equitable healthcare, but does not support our hypothesis for Asian and Hispanic patients, likely due to a small study population size, warranting further research into the topic.
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