Yin Clark, Sing David C, Curry Emily J, Abdul-Rassoul Hussein, Galvin Joseph W, Eichinger Josef K, Li Xinning
Orthopedics. 2019 Mar 1;42(2):95-102. doi: 10.3928/01477447-20190221-01. Epub 2019 Feb 27.
There is a paucity of data on how racial disparities may affect early outcomes following shoulder arthroplasty. The purpose of this study was to evaluate differences in 30-day complications and readmission rates after shoulder arthroplasty based on race. White and black patients who underwent hemiarthroplasty, anatomic or reverse total shoulder arthroplasty (Current Procedural Terminology codes 23470 and 23472) between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Black patients were propensity score matched 1:4 based on preoperative demographics and comorbidities to white patients. Multivariable analysis was performed to assess postoperative complications based on race. Of the 12,663 patients with shoulder arthroplasty identified, 10,717 (84.6%) were white and 559 (4.4%) were black. Overall, 557 black patients were matched to 2228 white patients, for a total cohort of 2785 patients (mean age, 63.9±11.7 years; female, 61.0%). Surgical indications were similar between black and white patients. The 2 races had similar rates of overall complications, major complications, minor complications, readmissions, and discharge to facility. Mortality was significantly higher among black patients compared with white patients (0.6% vs 0.05%; P=.033). Black patients also experienced longer operative time (mean, 126.4 vs 112.5 minutes; P<.001) and length of stay (mean, 2.4 vs 2.1 days; P<.001). There was a significant disparity with underutilization of shoulder arthroplasty for black patients in the American College of Surgeons National Surgical Quality Improvement Program database. Black and white patients undergoing shoulder arthroplasty experienced similar rates of 30-day complications, readmissions, and discharge to facility. However, black patients experienced greater operative time, total length of stay, and mortality compared with white patients. [Orthopedics. 2019; 42(2):95-102.].
关于种族差异如何影响肩关节置换术后早期结果的数据匮乏。本研究的目的是评估基于种族的肩关节置换术后30天并发症和再入院率的差异。在美国外科医师学会国家外科质量改进计划数据库中，识别出2006年至2015年间接受半关节置换术、解剖型或反向全肩关节置换术（现行手术操作术语编码23470和23472）的白人和黑人患者。根据术前人口统计学和合并症，将黑人患者与白人患者按倾向得分1:4进行匹配。进行多变量分析以评估基于种族的术后并发症。在识别出的12663例肩关节置换患者中，10717例（84.6%）为白人，559例（4.4%）为黑人。总体而言，557例黑人患者与2228例白人患者匹配，共2785例患者（平均年龄63.9±11.7岁；女性占61.0%）。黑人和白人患者的手术指征相似。两个种族的总体并发症、主要并发症、次要并发症、再入院率和转至医疗机构的出院率相似。与白人患者相比，黑人患者的死亡率显著更高（0.6%对0.05%；P=0.033）。黑人患者的手术时间也更长（平均126.4分钟对112.5分钟；P<0.001），住院时间更长（平均2.4天对2.1天；P<0.001）。在美国外科医师学会国家外科质量改进计划数据库中，黑人患者肩关节置换术的利用率明显不足，存在显著差异。接受肩关节置换术的黑人和白人患者30天并发症、再入院率和转至医疗机构的出院率相似。然而，与白人患者相比，黑人患者的手术时间更长、总住院时间更长且死亡率更高。[《骨科》。2019年；42(2):95-102。]
