John A Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA.
Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
Arch Orthop Trauma Surg. 2024 May;144(5):1937-1944. doi: 10.1007/s00402-024-05272-y. Epub 2024 Mar 27.
Previous arthroplasty utilization research predominantly examined Black and White populations within the US. This is the first known study to examine utilization and complications in poorly studied minority racial groups such as Asians and Native Hawaiian/Pacific-Islanders (NHPI) as compared to Whites.
Data from 3304 primary total hip and knee arthroplasty patients (2011 to 2019) were retrospectively collected, involving 1789 Asians (52.2%), 1164 Whites (34%) and 320 Native Hawaiians/Pacific Islanders (NHPI) (9.3%). The 2012 arthroplasty utilization rates for Asian, White, and NHPI increased by 32.5%, 11.2%, and 86.5%, respectively, by 2019. Compared to Asians, Whites more often underwent hip arthroplasty compared to knee arthroplasty (odds ratio (OR) 1.755; p < 0.001). Compared to Asians, Whites and NHPI more often received total knee compared to unicompartmental knee arthroplasty (White: OR 1.499; NHPI: OR 2.013; p < 0.001). White patients had longer hospitalizations (2.66 days) compared to Asians (2.19 days) (p = 0.005) following bilateral procedures. Medicare was the most common insurance for Asians (66.2%) and Whites (54.2%) while private insurance was most common for NHPI (49.4%). Compared to Asians, economic status was higher for Whites (White OR 0.695; p < 0.001) but lower for NHPI (OR 1.456; p < 0.001). After controlling for bilateral procedures, NHPI had a lower risk of transfusion compared to Asians (OR 0.478; p < 0.001) and Whites had increased risk of wound or systemic complications compared to Asians (OR 2.086; p = 0.045).
Despite NHPI demonstrating a significantly poorer health profile and lower socioeconomic status, contrary to previous literature involving minority racial groups, no significant overall differences in arthroplasty utilization rates or perioperative complications could be demonstrated amongst the racial groups examined.
之前的关节置换术利用研究主要在美国考察了黑人和白人。这是第一项已知的研究，比较了亚裔和夏威夷原住民/太平洋岛民（NHPI）等研究较少的少数族裔与白人之间的利用率和并发症。
回顾性收集了 2011 年至 2019 年 3304 例初次全髋关节和膝关节置换术患者的数据，其中包括 1789 名亚裔（52.2%）、1164 名白人（34%）和 320 名夏威夷原住民/太平洋岛民（9.3%）。到 2019 年，2012 年亚裔、白人、NHPI 的关节置换术利用率分别增加了 32.5%、11.2%和 86.5%。与亚洲人相比，白人更常接受髋关节置换术而不是膝关节置换术（比值比（OR）1.755；p<0.001）。与亚洲人相比，白人更常接受全膝关节置换术而不是单髁膝关节置换术（白人：OR 1.499；NHPI：OR 2.013；p<0.001）。白人患者在双侧手术后的住院时间（2.66 天）长于亚洲人（2.19 天）（p=0.005）。医疗保险是亚洲人（66.2%）和白人（54.2%）最常见的保险，而 NHPI 最常见的保险是私人保险（49.4%）。与亚洲人相比，白人的经济状况更高（白人 OR 0.695；p<0.001），而 NHPI 的经济状况更低（OR 1.456；p<0.001）。在控制了双侧手术后，NHPI 的输血风险低于亚洲人（OR 0.478；p<0.001），而白人的伤口或全身并发症风险高于亚洲人（OR 2.086；p=0.045）。
尽管 NHPI 表现出明显较差的健康状况和较低的社会经济地位，但与之前涉及少数族裔群体的文献相反，在所研究的种族群体中，关节置换术利用率或围手术期并发症方面并没有明显的总体差异。
