Peter Cram1,2,3, Gillian Hawker4, John Matelski5, Bheeshma Ravi6, Andrew Pugely7, Rajiv Gandhi6, Timothy Jackson8. 1. Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. peter.cram@uhn.ca. 2. Division of General Internal Medicine, Sinai Health System and University Health Network, Toronto General Hospital, Eaton 14th Floor, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. peter.cram@uhn.ca. 3. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA. peter.cram@uhn.ca. 4. Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. 5. Division of General Internal Medicine, Sinai Health System and University Health Network, Toronto General Hospital, Eaton 14th Floor, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. 6. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. 7. Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA. 8. Division of General Surgery, University Health Network, Toronto, ON, Canada.
Abstract
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) and (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.
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) and (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.
Entities:
Keywords:
African americans; Arthroplasty; Blood transfusion; Female; Male
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