Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York.
J Arthroplasty. 2024 May;39(5):1226-1234.e4. doi: 10.1016/j.arth.2023.11.003. Epub 2023 Nov 14.
Sex disparities have been noted across various aspects of total hip/knee arthroplasty (THA/TKA). Given incentives to standardize care, bundled payment initiatives including the Comprehensive Care for Joint Replacement (CJR) program may reduce disparities. This study aimed to assess the CJR program's impact on sex disparities in THA/TKA care and outcomes.
This retrospective cohort study included 259,673 THAs (61.7% women) and 506,311 TKAs (64.0% women) from a large national database (2013 to 2017). Sex disparities were assessed for care and outcomes related to the period (1) before surgery, (2) during hospitalization for THA/TKA, and (3) after discharge. Disparities were reported as women:men ratios. Difference-in-differences analyses estimated the impact of the CJR program on pre-existing sex disparities.
For both THA and TKA, women were less likely than men to present with a Charlson-Deyo comorbidity index >0 (women:men ratio 0.88 to 0.92), but were more likely to require blood transfusions (women:men ratio 1.48 to 1.79) and be discharged to institutional postacute care (women:men ratio 1.50 to 1.66). Difference-in-differences models demonstrated that the CJR bundled payment program reduced sex disparities in institutional postacute care discharges (THA: -2.28%; 95% confidence interval [CI] -4.20 to -0.35%, P = .02; TKA: -2.07%; 95% CI -3.93 to -0.20%; P = .03) and THA 90-day readmissions (-1.00%, 95% CI -1.88 to -0.13%, P = .02), indicating a differential impact of CJR in women versus men for some outcomes.
While sex disparities in THA/TKA persist, the CJR program demonstrates potential to impact such differences. Future research should focus on how potential mechanisms could be leveraged to reduce disparities.
在全髋关节置换术（THA）/全膝关节置换术（TKA）的各个方面都存在性别差异。鉴于激励措施来标准化护理，包括综合关节置换护理（CJR）计划的捆绑支付计划可能会减少差异。本研究旨在评估 CJR 计划对 THA/TKA 护理和结果中性别差异的影响。
这项回顾性队列研究包括来自大型国家数据库（2013 年至 2017 年）的 259673 例 THA（61.7%为女性）和 506311 例 TKA（64.0%为女性）。评估了与手术前（1）、THA/TKA 住院期间（2）和出院后（3）相关的护理和结果方面的性别差异。性别差异以女性与男性的比例报告。差异中的差异分析估计了 CJR 计划对先前存在的性别差异的影响。
对于 THA 和 TKA，女性的 Charlson-Deyo 合并症指数>0 的可能性均低于男性（女性与男性的比例为 0.88 至 0.92），但更有可能需要输血（女性与男性的比例为 1.48 至 1.79），并被送往机构康复治疗（女性与男性的比例为 1.50 至 1.66）。差异中的差异模型表明，CJR 捆绑支付计划减少了机构康复治疗出院的性别差异（THA：-2.28%；95%置信区间 [CI]：-4.20 至-0.35%，P=.02；TKA：-2.07%；95% CI：-3.93 至-0.20%；P=.03）和 THA 90 天再入院率（-1.00%；95% CI：-1.88 至-0.13%，P=.02），表明 CJR 对某些结果对女性和男性的影响存在差异。
尽管 THA/TKA 中仍然存在性别差异，但 CJR 计划显示出了影响这些差异的潜力。未来的研究应侧重于如何利用潜在机制来减少差异。
