Leonard Saskia, Lindquist Mark, Shimoda Brent, Pai Rachel, Weldon Rosana H, Kaneshiro Jeanae M, Nakasone Cass K
John A Burns School of Medicine, Honolulu, USA.
University of Hawai'i at Mānoa, Honolulu, USA.
Arch Orthop Trauma Surg. 2025 Jul 15;145(1):376. doi: 10.1007/s00402-025-05980-z.
Most studies investigating the influence of race on patient reported outcomes (PROs) compare Black and/or Hispanic patients to White patients. Few have examined differences in PROs between Native Hawaiian/Pacific Islander (NHPI), Asian, and White patients, which comprise most of the population of Hawai'i. The purpose of this study was to examine differences in perioperative PROs between NHPI, Asian, and White patients and discuss observed outcome disparities if present.
A retrospective evaluation of Asian, White and NHPI patients undergoing elective, unilateral total hip (THA) or total knee arthroplasty (TKA) between April 2019 and April 2023 was performed. Patient demographics, Charlson Comorbidity Index (CCI), Patient-Reported Outcomes Measurement Information System (PROMIS) global physical health (GPH) and global mental health (GMH), patient satisfaction, and Hip/Knee Disability and Osteoarthritis Outcome Score for Joint replacement (H/KOOS JR) were collected. Analysis of variance and chi-square tests were performed to detect differences between racial groups.
NHPI patients had the highest average body mass index (BMI, kg/m) and the largest proportion of patients classified as obese for both surgical groups. NHPI patients also reported the lowest preoperative H/KOOS JR, PROMIS GPH, and PROMIS GMH scores compared to Asian and White patients. However, by 1 year post surgery, there were no significant differences in H/KOOS JR and PROMIS GPH amongst NHPI, Asian and White patients. PROMIS GMH was not significantly different for TKA patients at 1 year post surgery, but was significantly different for THA patients, with NHPIs reporting the lowest scores.
NHPI patients undergoing TKA and THA reported poorer preoperative scores but achieved similar outcomes as Asian and White patients following surgery. Lower preoperative scores may be due to higher levels of obesity in NHPI patients, but these factors do not seem to be predictive of poorer outcomes.
大多数研究种族对患者报告结局（PROs）影响的研究，都是将黑人患者和/或西班牙裔患者与白人患者进行比较。很少有研究考察夏威夷原住民/太平洋岛民（NHPI）、亚裔和白人患者之间PROs的差异，而这三类人群构成了夏威夷的大部分人口。本研究的目的是考察NHPI、亚裔和白人患者围手术期PROs的差异，并讨论观察到的结局差异（如果存在的话）。
对2019年4月至2023年4月期间接受择期单侧全髋关节置换术（THA）或全膝关节置换术（TKA）的亚裔、白人和NHPI患者进行回顾性评估。收集患者人口统计学数据、Charlson合并症指数（CCI）、患者报告结局测量信息系统（PROMIS）全球身体健康（GPH）和全球心理健康（GMH）、患者满意度以及关节置换的髋关节/膝关节残疾和骨关节炎结局评分（H/KOOS JR）。进行方差分析和卡方检验以检测种族群体之间的差异。
在两个手术组中，NHPI患者的平均体重指数（BMI，kg/m）最高，被归类为肥胖的患者比例也最大。与亚裔和白人患者相比，NHPI患者术前的H/KOOS JR、PROMIS GPH和PROMIS GMH评分也最低。然而，术后1年时，NHPI、亚裔和白人患者的H/KOOS JR和PROMIS GPH没有显著差异。术后1年时，TKA患者的PROMIS GMH没有显著差异，但THA患者有显著差异，NHPI患者的评分最低。
接受TKA和THA的NHPI患者术前评分较差，但术后与亚裔和白人患者取得了相似的结局。术前评分较低可能是由于NHPI患者肥胖程度较高，但这些因素似乎并不能预测较差的结局。
