Researchers Assess Short-Term Risk Factors for Adverse Events in Black TKA Patients

A recent study evaluated time trends and risk factors for 30-day adverse events (AEs) among black patients who undergo total knee arthroplasty (TKA).

“Increased adverse events (AEs) have been reported among black patients undergoing joint arthroplasty, but little is known about their persistence and risk factors,” explained the study authors.

They performed a search of the American College of Surgeons National Surgical Quality Improvement Program for all primary TKAs performed from 2011 through 2017 on black patients. Data collection included time trends regarding demographic variables, comorbid conditions, perioperative characteristics, and length of stay (LOS), as well as 30-day outcomes including readmissions, reoperations, medical and surgical complications, and mortality.

Final analysis included 19,496 black TKA patients treated during the study period, during which time comorbidity profiles improved (P<0.02), LOS decreased (P<0.001), and the rate of AEs was reduced (P<0.001). The researchers identified the following risk factors associated with AEs: male gender, tobacco smoking, American Society of Anesthesiologists score >2, dependent functional status, congestive heart failure, chronic obstructive pulmonary disease, metastatic cancer, dyspnea, chronic kidney disease, bilateral TKA, and operative time >100 minutes.

The study was published in The Journal of Arthroplasty.

“There have been significant improvements in the annual trends of LOS and 30-day outcomes among black patients undergoing primary TKA in recent years. A predictive model for 30-day AEs was developed to help guide risk stratification and optimization of modifiable factors, namely anemia, tobacco smoking, bilateral surgery, and operative time,” the study authors concluded.

Racial Disparities in TKA: Discharge Disposition May Vary

A previous study observed differences between black and white TKA patients in terms of discharge disposition, with the former more likely to be discharged to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) instead of home.

For this study, published in JAMA Network Open, researchers analyzed 107,768 patients, of whom 7,287 (6.8%) were black, 68,372 (63.4%) were women, 46,420 (43.1%) were aged <65 years, and 60,636 (56.3%) were Medicare participants.

Black patients aged <65 years, compared to white patients, were more likely to be discharged to an IRF or SNF. Younger black patients were also more likely to require 90-day hospital readmission than white patients. Among the older cohort, black patients were more likely than white patients to be discharged to an SNF. Across both age groups, 90-day readmission risk was greater among patients discharged to an IRF or SNF.