Disparities in knee and hip arthroplasty outcomes: an observational analysis of the ACS-NSQIP clinical registry
Peter Cram, MD MBA,1,2,3 Gillian Hawker, MD MSc,1 John Matelski, MS,2 Bheeshma Ravi, MD PhD,4 Andrew Pugely, MD,3 Rajiv Gandhi, MD MS,4 and Timothy Jackson, MD MS5Hip Knee
Background
Disparities in total joint arthroplasty (TJA) have largely been studied in single center studies and using administrative data. Our objective was to investigate differences in TJA outcomes in white men, black men, white women, and black women using a large international registry.
Methods
We used 2010–2013 data from the ACS-NSQIP to identify four groups of adults (white men, black men, white women, black women) who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). We compared differences in: 1) surgical complications (mortality, pulmonary embolism, wound infection, sepsis, blood loss requiring transfusion, myocardial infarction, pneumonia, acute renal failure, and a composite representing occurrence of one-or-more adverse outcomes); 2) discharge to a nursing home.
Results
We identified 62,075 TKA and 39,334 THA patients. For TKA 35.3% were white men, 57.2% white women, 1.9% black men, and 5.6% black women. White and black women were significantly more likely to experience our composite outcome when compared to their male counterparts (16.5% and 14.1% for white women and white men; P<.001) (18.3% and 14.3% for black women and black men; P=.002); higher complications for women were explained by higher transfusion rates in women (14.9% vs 12.2% for white women and men, 16.4% vs 11.7% for black; P<.001 for both). For TKA blacks (compared to whites) and women (compared to men) were significantly more likely to be discharged to a nursing home. Results were similar for THA.
Conclusions
In contrast to prior studies, we found that complications after primary TJA were generally similar among white and black men and women with the exception of markedly higher transfusion rates among women of both racial groups.
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