Ezomo Olohirere T, Sun Daniel, Gronbeck Christian, Harrington Melvyn A, Halawi Mohamad J
The Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, CT, USA.
Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
Arthroplast Today. 2020 Nov 2;6(4):872-876. doi: 10.1016/j.artd.2020.10.002. eCollection 2020 Dec.
Little is known about the persistence of health disparities in joint arthroplasty. The objective of this study was to update our knowledge on the state of racial and ethnic disparities in total hip arthroplasty (THA).
Patients undergoing primary, elective THA using the 2011-2017 American College of Surgeons National Surgical Quality Improvement Program were retrospectively reviewed. Five minority groups (non-Hispanic black or African American, Hispanic or Latino, Asian, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander) were compared with non-Hispanic whites. The primary outcomes were in the differences in demographic characteristics, comorbidities, perioperative characteristics, THA utilization, length of stay (LOS), and 30-day adverse events (mortality, readmission, reoperation, and complications).
A total of 155,870 patients were identified with racial and ethnic data available on 134,961 (86.6%) of them. Non-Hispanic white patients comprised 74.5% of all THA procedures. Except for Asians, all minority groups were more likely to be younger, have a higher body mass index, and smoke tobacco ( < .001). There were higher rates of nonprimary osteoarthritis, procedure length exceeding 100 minutes, and comorbidities among all minority groups. All minority groups, except Asian and Hawaiians or Pacific Islanders, were more likely to require an LOS >2 days. Blacks were more likely to develop surgical or medical complications (odds ratio [OR]: 1.21 and 1.2, respectively), whereas Hispanics or Latinos were more likely to develop surgical complications (OR: 1.28). American Indians or Alaska Natives were more likely to undergo reoperations (OR: 1.91).
Health disparities persist among minority groups with respect to comorbidities, THA utilization, LOS, and complications. Blacks and Hispanics or Latinos appear to be the most impacted by these disparities.
关于关节置换术中健康差异的持续性，人们了解甚少。本研究的目的是更新我们对全髋关节置换术（THA）中种族和民族差异状况的认识。
对2011 - 2017年美国外科医师学会国家外科质量改进计划中接受初次择期THA的患者进行回顾性研究。将五个少数族裔群体（非西班牙裔黑人或非裔美国人、西班牙裔或拉丁裔、亚裔、美国印第安人或阿拉斯加原住民、夏威夷原住民或太平洋岛民）与非西班牙裔白人进行比较。主要结局指标包括人口统计学特征、合并症、围手术期特征、THA利用率、住院时间（LOS）以及30天不良事件（死亡率、再入院率、再次手术率和并发症）的差异。
共识别出155,870例患者，其中134,961例（86.6%）有可用的种族和民族数据。非西班牙裔白人患者占所有THA手术的74.5%。除亚裔外，所有少数族裔群体更可能年龄较轻、体重指数较高且吸烟（P <.001）。所有少数族裔群体中非原发性骨关节炎、手术时间超过100分钟以及合并症的发生率更高。除亚裔和夏威夷原住民或太平洋岛民外，所有少数族裔群体更可能需要住院时间>2天。黑人更可能发生手术或医疗并发症（优势比[OR]分别为：1.21和1.2），而西班牙裔或拉丁裔更可能发生手术并发症（OR：1.28）。美国印第安人或阿拉斯加原住民更可能接受再次手术（OR：1.91）。
少数族裔群体在合并症、THA利用率、住院时间和并发症方面的健康差异仍然存在。黑人和西班牙裔或拉丁裔似乎受这些差异影响最大。
