Disparities in Knee and Hip Arthroplasty Outcomes: an Observational Analysis of the ACS-NSQIP Clinical Registry.
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.



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.



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.



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.
Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. peter.cram@uhn.ca.|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.|Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA. peter.cram@uhn.ca.
Peter
0000-0002-1910-346X
P
Cram
Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
Gillian
G
Hawker
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.
John
J
Matelski
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
Bheeshma
B
Ravi
Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
Andrew
A
Pugely
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
Rajiv
R
Gandhi
Division of General Surgery, University Health Network, Toronto, ON, Canada.
Timothy
T
Jackson
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012042:Registries; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
African americans; Arthroplasty; Blood transfusion; Female; Male