JSES reviews, reports, and techniques · 2025
Patient race and ethnicity are associated with higher unplanned 90-day emergency department visits and readmissions but not 10-year all-cause complications or reoperations: a matched cohort analysis of primary shoulder arthroplasties.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Marigi Erick M, Alder Kareme D, Yu Kristin E, Johnson Quinn J, Marigi Ian M, Schoch Bradley S, Tokish John M, Sanchez-Sotelo Joaquin, Barlow Jonathan D
Аннотация
BACKGROUND: Within orthopedic surgery, there remain limited data evaluating the impact of racial and socioeconomic disparities on outcomes of primary shoulder arthroplasty (SA) over time. As such, we analyzed both short- and longer-term outcome differences in complications, reoperations, and revision surgery of primary SA when performed in non-White patients when compared to a matched cohort of White patients who had undergone SA.
METHODS: Over a 39-year period (1981-2020), an institutional Total Joint Registry Database was utilized to identify all non-White patients (Asian/Pacific Islander, Black, Hispanic or Latino, American Indian/Alaska Native, other) who underwent primary SA with a minimum of 2 years of follow-up. The search identified 275 primary SA (46 hemiarthroplasties, 97 anatomic total shoulder arthroplasties, and 132 reverse total shoulder arthroplasties). The ethnicity composition was 8.7% Asian, 27.3% Black, 37.8% Hispanic, 12.4% American Indian, and 13.8% other. This cohort was matched 1:2 according to age, sex, diagnosis, implant, and surgical year to a control group of 550 White patients who had undergone SA. The rates of medical and surgical complications, reoperations, revisions, and implant survivorship were assessed. The mean follow-up time was 6.3 years (range, 2 to 40 years).
RESULTS: Comparisons between the non-White and White matched cohorts demonstrated a higher rate of tobacco use (14.2% vs. 10.5%; P < .001), diabetes (21.5% vs. 11.8%; P < .001), length of stay (1.9 vs. 1.6 days; P = .014), and a lower rate of private commercial insurance (27.3% vs. 44.5%; P < .001 in the non-White cohort. Within the first 90 days after surgery, non-White patients had a higher rate of emergency department visits (5.5% vs. 0.9%; P < .001) and unplanned readmissions (2.9% vs. 0.7%; P = .014). After the first 90 postoperative days, there were no differences regarding medical (1.8% vs. 0.7%; P = .135) or surgical complications (12.0% vs. 13.6%; P = .446). Ten-year survivorship free of all-cause complication (76.8% vs. 81.5%; P = .370), reoperation (84.9% vs. 89.8%; P = .492), and revision (89.3% vs. 91.4%; P = .715) were similar between the non-White and White cohorts.
DISCUSSION: After accounting for age, sex, and surgical indication, patient race and ethnicity were not associated with an increased risk of long-term all-cause complications, reoperations, or revision surgery after primary SA. However, within the first 90 postoperative days, non-White patients had a higher likelihood of unplanned emergency room visits and readmissions.
METHODS: Over a 39-year period (1981-2020), an institutional Total Joint Registry Database was utilized to identify all non-White patients (Asian/Pacific Islander, Black, Hispanic or Latino, American Indian/Alaska Native, other) who underwent primary SA with a minimum of 2 years of follow-up. The search identified 275 primary SA (46 hemiarthroplasties, 97 anatomic total shoulder arthroplasties, and 132 reverse total shoulder arthroplasties). The ethnicity composition was 8.7% Asian, 27.3% Black, 37.8% Hispanic, 12.4% American Indian, and 13.8% other. This cohort was matched 1:2 according to age, sex, diagnosis, implant, and surgical year to a control group of 550 White patients who had undergone SA. The rates of medical and surgical complications, reoperations, revisions, and implant survivorship were assessed. The mean follow-up time was 6.3 years (range, 2 to 40 years).
RESULTS: Comparisons between the non-White and White matched cohorts demonstrated a higher rate of tobacco use (14.2% vs. 10.5%; P < .001), diabetes (21.5% vs. 11.8%; P < .001), length of stay (1.9 vs. 1.6 days; P = .014), and a lower rate of private commercial insurance (27.3% vs. 44.5%; P < .001 in the non-White cohort. Within the first 90 days after surgery, non-White patients had a higher rate of emergency department visits (5.5% vs. 0.9%; P < .001) and unplanned readmissions (2.9% vs. 0.7%; P = .014). After the first 90 postoperative days, there were no differences regarding medical (1.8% vs. 0.7%; P = .135) or surgical complications (12.0% vs. 13.6%; P = .446). Ten-year survivorship free of all-cause complication (76.8% vs. 81.5%; P = .370), reoperation (84.9% vs. 89.8%; P = .492), and revision (89.3% vs. 91.4%; P = .715) were similar between the non-White and White cohorts.
DISCUSSION: After accounting for age, sex, and surgical indication, patient race and ethnicity were not associated with an increased risk of long-term all-cause complications, reoperations, or revision surgery after primary SA. However, within the first 90 postoperative days, non-White patients had a higher likelihood of unplanned emergency room visits and readmissions.