Rudisill Samuel S, Varady Nathan H, Birir Aseal, Goodman Susan M, Parks Michael L, Amen Troy B
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Rush Medical College of Rush University, Chicago, Illinois.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2023 Jan;38(1):171-187.e18. doi: 10.1016/j.arth.2022.08.006. Epub 2022 Aug 17.
Total joint arthroplasty (TJA) is one of the most common surgical procedures in the United States; however, racial and ethnic disparities in utilizations and outcomes have been well documented. This systematic review and meta-analysis investigated associations between race/ethnicity and several metrics in total hip arthroplasty (THA) and total knee arthroplasty (TKA).
In August 2021, PubMed, Scopus, CINAHL, and SPORTDiscus databases were queried. Sixty three studies investigating racial/ethnic disparities in TJA utilizations, complications, mortalities, lengths of stay (LOS), discharge dispositions, readmissions, and reoperations were included. Study quality was assessed using a modified Newcastle-Ottawa Scale.
A majority of studies demonstrated disparities in TJA utilizations and outcomes. Black patients exhibited higher rates of 30-day complications (THA odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.29; TKA OR 1.20, 95% CI 1.10-1.31), 30-day mortality (THA OR 1.27, 95% CI 1.08-1.48), prolonged LOS (THA mean difference [MD] +0.27 days, 95% CI 0.21-0.33; TKA MD +0.30 days, 95% CI 0.20-0.40), nonhome discharges (THA OR 1.47, 95% CI 1.37-1.57; TKA OR 1.65, 95% CI 1.38-1.96), and 30-day readmissions (THA OR 1.13, 95% CI 1.08-1.19; TKA OR 1.19, 95% CI 1.16-1.21) than White patients. Rates of complications (THA 1.18, 95% CI 1.03-1.36), prolonged LOS (TKA MD +0.20 days, 95% CI 0.17-0.23), and nonhome discharges (THA OR 1.26, 95% CI 1.10-1.45; TKA OR 1.37, 95% CI 1.22-1.53) were also increased among Hispanic patients, while Asian patients experienced longer LOS (TKA MD +0.09 days, 95% CI 0.05-0.12) but fewer readmissions. Outcomes among American Indian-Alaska Native and Pacific Islander patients were infrequently reported but similarly inequitable.
Racial and ethnic disparities in TJA utilizations and outcomes are apparent, with minority patients often demonstrating lower rates of utilizations and worse postoperative outcomes than White patients. Continued research is needed to evaluate the efficacy of recent efforts dedicated to eliminating inequalities in TJA care.
IV.
全关节置换术（TJA）是美国最常见的外科手术之一；然而，其在利用率和治疗结果方面的种族和民族差异已有充分记录。本系统评价和荟萃分析调查了种族/民族与全髋关节置换术（THA）和全膝关节置换术（TKA）中几个指标之间的关联。
2021年8月，对PubMed、Scopus、CINAHL和SPORTDiscus数据库进行了查询。纳入了63项调查TJA在利用率、并发症、死亡率、住院时间（LOS）、出院处置、再入院和再次手术方面种族/民族差异的研究。使用改良的纽卡斯尔-渥太华量表评估研究质量。
大多数研究表明TJA在利用率和治疗结果方面存在差异。黑人患者30天并发症发生率（THA优势比[OR]1.18，95%置信区间[CI]1.08-1.29；TKA OR 1.20，95%CI 1.10-1.31）、30天死亡率（THA OR 1.27，95%CI 1.08-1.48）、住院时间延长（THA平均差[MD]+0.27天，95%CI 0.21-0.33；TKA MD+0.30天，95%CI 0.
