title: Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty.
abstract: OBJECTIVE
  The utilization of joint arthroplasty for knee or hip osteoarthritis varies markedly by patient race/ethnicity. Because of concerns about surgical risk, black patients are less willing to consider this treatment. There are few published race/ethnicity-specific data on joint arthroplasty outcomes. The present study was undertaken to examine racial/ethnic differences in mortality and morbidity following elective knee or hip arthroplasty.
  
  
  METHODS
  Using information from the Veterans Administration National Surgical Quality Improvement Program database, data on 12,108 patients who underwent knee arthroplasty and 6,703 patients who underwent hip arthroplasty over a 5-year period were analyzed. Racial/ethnic differences were determined using prospectively collected data on patient characteristics, procedures, and short-term outcomes. The main outcome measures were risk-adjusted 30-day mortality and complication rates.
  
  
  RESULTS
  Adjusted rates of both non-infection-related and infection-related complications after knee arthroplasty were higher among black patients compared with white patients (relative risk [RR] 1.50, 95% confidence interval [95% CI] 1.08-2.10 and RR 1.42, 95% CI 1.06-1.90, respectively). Hispanic patients had a significantly higher risk of infection-related complications after knee arthroplasty (RR 1.64, 95% CI 1.08-2.49) relative to otherwise similar white patients. Race/ethnicity was not significantly associated with the risk of non-infection-related complications (RR 0.97, 95% CI 0.68-1.38 in blacks; RR 1.18, 95% CI 0.60-2.30 in Hispanics) or infection-related complications (RR 1.27, 95% CI 0.91-1.78 in blacks; RR 1.22, 95% CI 0.63-2.36 in Hispanics) after hip arthroplasty. The overall 30-day mortality was 0.6% following knee arthroplasty and 0.7% following hip arthroplasty, with no significant differences by race/ethnicity observed for either procedure.
  
  
  CONCLUSIONS
  Although absolute risks of complication are low, our findings indicate that, after adjustment, black patients have significantly higher rates of infection-related and non-infection-related complications following knee arthroplasty, compared with white patients. In addition, adjusted rates of infection-related complications after knee arthroplasty are higher in Hispanic patients than in white patients. Such differences between ethnic groups are not seen following hip arthroplasty. These groups do not appear to differ significantly in terms of post-arthroplasty mortality rates.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania 15240, USA. said.ibrahim2@med.va.gov
authors.forename: Said A
authors.initials: SA
authors.lastname: Ibrahim
authors.forename: Roslyn A
authors.initials: RA
authors.lastname: Stone
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Han
authors.forename: Peter
authors.initials: P
authors.lastname: Cohen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Shukri F
authors.initials: SF
authors.lastname: Khuri
authors.forename: C Kent
authors.initials: CK
authors.lastname: Kwoh
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American