Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2024 Jul;33(7):1536-1546. doi: 10.1016/j.jse.2023.11.008. Epub 2024 Jan 3.
In the United States, efforts to improve efficiency and reduce healthcare costs are shifting more total shoulder arthroplasty (TSA) surgeries to the outpatient setting. However, whether racial and ethnic disparities in access to high-quality outpatient TSA care exist remains to be elucidated. The purpose of this study was to assess racial/ethnic differences in relative outpatient TSA utilization and perioperative outcomes using a large national surgical database.
White, Black, and Hispanic patients who underwent TSA between 2017 and 2021 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Baseline demographic and clinical characteristics were collected, and rates of outpatient utilization, adverse events, readmission, reoperation, nonhome discharge, and mortality within 30 days of surgery were compared between racial/ethnic groups. Race/ethnicity-specific trends in utilization of outpatient TSA were assessed, and multivariable logistic regression was used to adjust for baseline demographic factors and comorbidities.
A total of 21,186 patients were included, consisting of 19,135 (90.3%) White, 1093 (5.2%) Black, and 958 (4.5%) Hispanic patients and representing 17,649 (83.3%) inpatient and 3537 (16.7%) outpatient procedures. Black and Hispanic patients were generally younger and less healthy than White patients, yet incidences of complications, nonhome discharge, readmission, reoperation, and death within 30 days were similar across groups following outpatient TSA (P > .050 for all). Relative utilization of outpatient TSA increased by 28.7% among White patients, 29.5% among Black patients, and 38.6% among Hispanic patients (p<0.001 for all). Hispanic patients were 64% more likely than White patients to undergo TSA as an outpatient procedure across the study period (OR: 1.64, 95% CI 1.40-1.92, P < .001), whereas odds did not differ between Black and White patients (OR: 1.04, 95% CI 0.87-1.23, P = .673).
Relative utilization of outpatient TSA remains highest among Hispanic patients but has been significantly increasing across all racial and ethnic groups, now accounting for more than one-third of all TSA procedures. Considering outpatient TSA is associated with fewer complications and lower costs, increasing utilization may represent a promising avenue for reducing disparities in orthopedic shoulder surgery.
在美国，提高效率和降低医疗保健成本的努力促使更多的全肩关节置换术 (TSA) 手术转移到门诊进行。然而，在获得高质量门诊 TSA 护理方面是否存在种族和民族差异仍有待阐明。本研究的目的是使用大型国家手术数据库评估种族/民族差异在相对门诊 TSA 利用和围手术期结果方面的差异。
从美国外科医师学院国家手术质量改进计划 (NSQIP) 数据库中确定了 2017 年至 2021 年期间接受 TSA 的白人、黑人、和西班牙裔患者。收集基线人口统计学和临床特征，并比较种族/民族组之间门诊利用、不良事件、再入院、再次手术、非家庭出院和术后 30 天内死亡率的比率。评估门诊 TSA 利用的种族/民族特定趋势，并使用多变量逻辑回归调整基线人口统计学因素和合并症。
共纳入 21186 例患者，其中 19135 例（90.3%）为白人，1093 例（5.2%）为黑人，958 例（4.5%）为西班牙裔患者，分别代表 17649 例（83.3%）住院和 3537 例（16.7%）门诊手术。黑人患者和西班牙裔患者通常比白人患者年轻且健康状况较差，但在门诊 TSA 后，各组的并发症、非家庭出院、再入院、再次手术和 30 天内死亡的发生率相似（所有 P>.05）。白人患者门诊 TSA 的相对利用率增加了 28.7%，黑人患者增加了 29.5%，西班牙裔患者增加了 38.6%（所有 P<.001）。在整个研究期间，西班牙裔患者接受 TSA 作为门诊手术的可能性比白人患者高 64%（OR：1.64，95%CI 1.40-1.92，P<.001），而黑人患者与白人患者之间的几率没有差异（OR：1.04，95%CI 0.87-1.23，P=.673）。
门诊 TSA 的相对利用率在西班牙裔患者中仍然最高，但在所有种族和民族群体中都显著增加，现在占所有 TSA 手术的三分之一以上。考虑到门诊 TSA 与较少的并发症和较低的成本相关，增加利用率可能是减少骨科肩部手术差异的一个有前途的途径。
