Racial Disparities Persist in Total Knee Arthroplasty Outcomes

Racial and ethnic disparities are still a concern when it comes to total knee arthroplasty (TKA) outcomes, according to an analysis.

The study authors queried data from the National Surgical Quality Improvement Program spanning 2011 through 2017 on primary TKA patients in order to evaluate differences in demographic, comorbidity burden, perioperative factors, procedure utilization, hospital length of stay (LOS), and 30-day outcomes. Minority patients defined per the National Institutes of Health (blacks/African Americans, Hispanics/Latinos, Asians, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders) were compared to non-Hispanic white patients.

An analysis of 262,954 patient records was performed, for which racial identification was available for 230,712 patients (87.7%). Nearly three-quarters of TKA procedures (72.5%) were performed in white patients. The rates of comorbidities including diabetes, hypertension, and anemia, as well as prolonged surgery times, were higher among racial and ethnic minority patients (P<0.001). Black/African American patients had significantly evident baseline disparities, including higher rates of tobacco smoking and congestive heart failure (P<0.001). When controlling for baseline differences, significant racial and ethnic disparities were still observed; particularly, black/African American and Hispanic/Latino patients were more likely to sustain complications and require readmission (P<0.001). LOS was longer in all racial and ethnic groups except for Asians (P<0.001), who were much less likely to require readmission or reoperation, or sustain complications (P<0.001).

The analysis was published in the Journal of Racial and Ethnic Disparities.

“Racial and ethnic disparities remain a public health challenge for patients undergoing TKA. While initiatives aimed at improving preoperative disease-burden and comorbidity profiles represent an important step, they alone are insufficient to fully account for or eliminate the disparities in TKA outcomes,” the researchers concluded.

Previous research has analyzed racial disparities among TKA patients, including a study published in June assessing 30-day adverse events (AEs) in black patients. The study observed “significant improvements in the annual trends of LOS and 30-day outcomes among black patients undergoing primary TKA in recent years.” Factors associated with AEs were: 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.