Racial disparities in surgery for thumb carpometacarpal osteoarthritis

Thumb carpometacarpal (CMC) osteoarthritis is among the most prevalent degenerative conditions of the upper extremity. For symptomatic disease that has failed nonoperative management, surgical treatment in the United States has historically centered on resection arthroplasty (RA) with or without ligament reconstruction and tendon interposition, while in Europe prosthetic CMC arthroplasty has progressively replaced ligamentoplasty as the dominant operative strategy. Using a national Medicare database, this study examined whether patient race is associated with the likelihood of undergoing surgery for thumb CMC osteoarthritis.

A retrospective cohort study was conducted using the 2015-2016 Medicare Standard Analytic Files (SAF), a national administrative database of 61 million patients that utilizes administrative coding. Patients with CMC osteoarthritis were identified using International Classification of Disease (ICD) codes. Operative treatment (resection arthroplasty (RA) with or without tendon interposition or transfer) was identified with Current Procedural Terminology (CPT) codes. Demographics, including patient race, sex, age, and Elixhauser Comorbidity Index (ECI), were abstracted. A secondary analysis used a 1:4 race-matched cohort of Black and White patients. Statistical tests included univariable comparisons and multivariable logistic regression, controlling for age, sex, and ECI. Significance was defined as p < 0.05.

Of 108,512 Medicare beneficiaries with thumb CMC osteoarthritis, 44,845 (41.3%) underwent surgery during the study period. On multivariable analysis, surgical utilization was highest in those aged ≤64 years and declined with each successive age group (p < 0.001). Men were less likely to undergo surgery than women (OR 0.84, 95% CI 0.80-0.89, p < 0.001). Compared with White patients, adjusted odds of surgery were significantly lower for Black (OR 0.44, 95% CI 0.38-0.50), Asian (OR 0.22, 95% CI 0.13-0.34), Hispanic (OR 0.30, 95% CI 0.20-0.42), and Native American (OR 0.45, 95% CI 0.27-0.69) patients (all p ≤ 0.001). Race-based differences persisted in the matched cohort.

Across all racial minority groups examined, Medicare beneficiaries were substantially less likely to undergo surgery for thumb CMC osteoarthritis than White patients, independent of age, sex, and comorbidity.