title: The influence of race and ethnicity on complications and mortality after orthopedic surgery: a systematic review of the literature.
abstract: BACKGROUND
  The decision to perform orthopedic surgery requires substantial discretion and judgment. Similar conditions have been associated with health care disparities in other fields, but the extent of racial and ethnic disparities in orthopedics is unknown.
  
  
  OBJECTIVE
  To evaluate the quality of extant orthopedic literature on health care disparities.
  
  
  METHODS
  This study is a systematic review.
  
  
  METHODS
  Eligible studies reported complications and/or mortality stratified by minority group after orthopedic surgery in an American population.
  
  
  METHODS
  Queries of PubMed, Embase, Scopus, and Web of Science were performed. Included papers were abstracted regarding complication and/or mortality rates for whites and minority populations, statistical findings, and whether a health care disparity was reported. Statistical associations between study characteristics and the identification of disparities were evaluated using the χ test.
  
  
  RESULTS
  The literature search returned 2604 studies, of which 33 met inclusion criteria. All but 3 works dealt with spine surgery or joint replacement. Twenty-one publications (64%) documented health care disparities. Forty-four percent of efforts investigating outcomes for Hispanics and 36% of works documenting results for non-whites recorded a disparity. Investigations reporting on African Americans were significantly more likely to identify health care inequalities (77%) as compared with non-white (P=0.02) cohorts.
  
  
  CONCLUSIONS
  Patients from racial and ethnic minority populations seem to be at increased risk of complications and/or mortality following spine surgical or joint replacement procedures. There is insufficient evidence to support generalization to the entire orthopedic field. Studies specific to African American patients identify health care disparities at a significantly higher rate than those utilizing non-white cohorts.
authors.affiliation: *Robert Wood Johnson Clinical Scholars Program, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor Veterans Administration Hospital †Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, University of Michigan, Ann Arbor, MI ‡Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX §Department of Orthopaedic Surgery ∥Robert Wood Johnson Clinical Scholars Program, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Renuka
authors.initials: R
authors.lastname: Tipirneni
authors.forename: James H
authors.initials: JH
authors.lastname: Nelson
authors.forename: James E
authors.initials: JE
authors.lastname: Carpenter
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
mesh_terms: D005006:Ethnicity / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000208:ethnology* / Q000401:mortality*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies