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Racial Disparities in Treatment and Outcomes of Patients With Hepatitis C Undergoing Elective Total Joint
Cole M Howie1, Kyle H Cichos2, Mohamed G Shoreibah1
1Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Insights
Black patients with Hepatitis C virus (HCV) undergoing joint replacement surgery were less likely to receive treatment, leading to higher viral loads and longer hospital stays. Addressing these disparities is crucial for improving outcomes in total hip and knee arthroplasty.
Area of Science:
- Orthopedic Surgery
- Hepatology
- Health Disparities Research
Background:
- African Americans exhibit the highest prevalence of chronic Hepatitis C virus (HCV) infection.
- Observed racial disparities in outcomes following elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Purpose of the Study:
- To investigate disparities in treatment and outcomes for Black and White patients with HCV undergoing elective THA and TKA.
- To identify if race influences the management and results of arthroplasty in HCV-positive patients.
Main Methods:
- Comparative analysis of patient demographics, comorbidities, HCV characteristics, and perioperative variables.
- Evaluation of in-hospital outcomes and 1-year postoperative complications between Black and White patients.
- Statistical comparison using Chi-square, Fisher's exact, and Kruskal-Wallis tests, with significance set at P < .05.
Main Results:
- Black patients had higher preoperative liver function parameters and model for end-stage liver disease scores.
- Black patients were more likely to undergo THA and TKA without prior HCV treatment, resulting in higher rates of preoperative positive viral load (PVL).
- Black patients experienced longer hospital lengths of stay for both THA and TKA procedures.
Conclusions:
- HCV treatment with undetectable viral load before THA/TKA is key to mitigating postoperative complications like joint infection.
- Black patients undergoing arthroplasty were disproportionately more likely to have not received HCV treatment and have PVL.
- Despite a general decrease in PVL over time, a significant racial gap persists, highlighting ongoing disparities for Black patients.
Background:
African Americans have the highest prevalence of chronic Hepatitis C virus (HCV) infection. Racial disparities in outcome are observed after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study sought to identify if disparities in treatments and outcomes exist between Black and White patients who have HCV prior to elective THA and TKA.
Methods:
Patient demographics, comorbidities, HCV characteristics, perioperative variables, in-hospital outcomes, and postoperative complications at 1-year follow-up were collected and compared between the 2 races. Patients who have preoperative positive viral load (PVL) and undetectable viral load were identified. Chi-square and Fisher's exact tests were used to compare categorical variables, while 2-tailed Student's Kruskal-Wallis t-tests were used for continuous variables. A P value of less than .05 was statistically significant.
Results:
The liver function parameters, including aspartate aminotransferase and model for end-stage liver disease scores, were all higher preoperatively in Black patients undergoing THA (P = .01; P < .001) and TKA (P = .03; P = .003), respectively. Black patients were more likely to undergo THA (65.8% versus 35.6%; P = .002) and TKA (72.1% versus 37.3%; 0.009) without receiving prior treatment for HCV. Consequently, Black patients had higher rates of preoperative PVL compared to White patients in both THA (66% versus 38%, P = .006) and TKA (72% versus 37%, P < .001) groups. Black patients had a longer length of stay for both THA (3.7 versus 3.3; P = .008) and TKA (4.1 versus 3.0; P = .02).
Conclusions:
The HCV treatment prior to THA and TKA with undetectable viral load has been shown to be a key factor in mitigating postoperative complications, including joint infection. We noted that Black patients were more likely to undergo joint arthroplasty who did not receive treatment and with a PVL. While PVL rates decreased over time for both races, a significant gap persists for Black patients.
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