Optimizing Total Hip and Knee Arthroplasty Among an Underserved Population: Lessons Learned From a...

Area of Science:

• Orthopedic Surgery
• Health Equity
• Quality Improvement

Background:

• Under-represented minorities and patients with noncommercial insurance face higher complication rates after total joint arthroplasty (TJA).
• A Medicaid Clinic implemented a preoperative optimization protocol to address disparities in TJA outcomes.
• This study evaluates the protocol's effectiveness and identifies challenges in managing this patient group.

Purpose of the Study:

• To assess the effectiveness of a preoperative optimization protocol for TJA in a Medicaid Clinic.
• To identify challenges in caring for an underserved TJA patient population.
• To evaluate the impact of the protocol on postoperative complications.

Main Methods:

• Retrospective analysis of 117 patients undergoing TJA between January 2015 and January 2020.
• Comparison between patients in a Medicaid Clinic and a private office control group.
• Collection of demographic data, American Society of Anesthesiologists scores, and postoperative complications.

Main Results:

• Medicaid Clinic patients were more likely to be Hispanic and Spanish-speaking compared to the office group (P=.0001).
• Clinic patients experienced significantly more postoperative complications than office patients (20 vs 7).
• The optimization protocol did not significantly alter complication or reoperation rates within the clinic group.

Conclusions:

• The study highlights the demographic and comorbidity profile of an underserved TJA population.
• The implemented quality improvement initiative failed to improve postoperative outcomes.
• Further research is essential to enhance outcomes and promote health equity for this demographic.