Outpatient Total Joint Arthroplasty: Are We Closing the Racial Disparities Gap?

• Published in: Journal of racial and ethnic health disparities 2023-10, Vol.10 (5), p.2320-2326
• Main Authors: Piponov, Hristo, Acquarulo, Blake, Ferreira, Andre, Myrick, Karen, Halawi, Mohamad J.
• Format: Article
• Language: English
• Subjects: African Americans; American Indians; Arthroplasty; Arthroplasty (hip); Arthroplasty (knee); Biomedical materials; Body mass index; Body size; Chronic obstructive pulmonary disease; Comorbidity; Complications; Epidemiology; Ethnic differences; Ethnic groups; Functional status; Health disparities; Health status; Inpatient care; Joint replacement surgery; Joints (anatomy); Linear analysis; Medicine; Medicine & Public Health; Minority & ethnic groups; Pacific Islander people; Quality control; Quality management; Quality of Life Research; Race factors; Racial inequality; Readmission; Social Inequality; Social Structure; Surgery
• ISSN: 2197-3792; 2196-8837
• DOI: 10.1007/s40615-022-01411-6

Introduction As ne arly half of all total joint arthroplasty (TJA) procedures are projected to be performed in the outpatient setting by 2026, the impact of this trend on health disparities remains to be explored. This study investigated the racial/ethnic differences in the proportion of TJA performed as outpatient as well as the impact of outpatient surgery on 30-day complication and readmission rates. Methods The ACS National Surgical Quality Improvement Program was retrospectively reviewed for all patients who underwent primary, elective total hip and knee arthroplasty (THA, TKA) between 2011 and 2018. The proportion of TJA performed as an outpatient, 30-day complications, and 30-day readmission among African American, Hispanic, Asian, Native American/Alaskan, and Hawaiian/Pacific Islander patients were each compared to White patients (control group). Analyses were performed for each racial/ethnic group separately. A general linear model (GLM) was used to calculate the odds ratios for receiving TJA in an outpatient vs. inpatient setting while adjusting for age, gender, body mass index (BMI), functional status, and comorbidities. Results In total, 170,722 THAs and 285,920 TKAs were analyzed. Compared to White patients, non-White patients had higher likelihood of THA or TKA performed as an outpatient (OR 1.31 and 1.24 respectively for African American patients, OR 1.65 and 1.76 respectively for Hispanic patients, and OR 1.66 and 1.59 respectively for Asian patients, p   0.05). However, readmission rates were significantly higher for outpatient TKA in all the study groups compared to inpatient TKA (OR range 2.47–10.15, p