Association between immigration status and total knee arthroplasty outcomes in Ontario, Canada: a population-based
Johnathan R Lex1, Daniel Pincus2, J Michael Paterson2
1From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker) johnathan.lex@mail.utoronto.ca.
Background:
Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients.
Methods:
We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups.
Results:
We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period (p < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, p < 0.001), infection (p < 0.001), death (p = 0.004), and surgical complications (p < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation (p < 0.001) and less likely to present to the emergency department (p < 0.001) than Canadian-born patients.
Conclusion:
Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty.
More Related Videos
07:33In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty
Published on: May 5, 2023
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022