Racial and ethnic disparity in shoulder surgery: a systematic review

Health care disparity exists in utilization and delivery of musculoskeletal care and continues to be an obstacle for orthopedic health care providers to mitigate. Racial and ethnic disparities exist within various surgical fields including orthopedic surgery and are expected to continue to rise in upcoming years. The aim of this systematic review is to analyze the racial and ethnic disparities on utilization and outcomes after common shoulder surgical procedures.

A primary literature search was performed using PubMed, Embase, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases using comprehensive Medical Subject Headings and subject-heading search terms. Studies were included if they reported utilization and or outcomes across 2 or more racial/ethnic groups in patients (age >16) who underwent total shoulder arthroplasty (TSA), rotator cuff repair (RCR), arthroscopic Bankart repair, Latarjet procedure, and open reduction internal fixation of proximal humerus fracture (PHF). Baseline demographics, data on procedure utilization, perioperative measures including mortality, operative time, length of stay, readmission, and complications were extracted from included studies, and descriptive statistical analysis performed.

Eighteen studies were identified for full text review of which 13 found race and ethnicity as factors affecting utilization and outcomes in TSA, RCR, arthroscopic Bankart repair, Latarjet procedure, and open reduction internal fixation of PHF. Compared to White patients, Black patients were found to have decreased utilization, longer length of stay, and greater operative time and mortality after TSA; Black patients also had longer operative times and time to discharge, and lower levels of reported satisfaction after RCR. Hispanic/Latino ethnicity was reported as an independent risk factor for postoperative falls following TSA. Hispanic/Latino and Black patients have a higher risk of delayed surgery and greater risk of readmission after surgical treatment of PHF compared to patients of White race.

This systematic review highlights the limited literature reporting the existence of racial and ethnic disparities in utilization and outcomes after common shoulder surgical procedures. Additionally, there is a paucity of studies exploring the underlying etiology of racial and ethnic disparity in outcomes after shoulder surgery. More research is necessary to pave the way for evidence-based action plans to mitigate health care disparities after shoulder surgeries, but this review serves as a baseline for where efforts in direct improvement can begin.