Director, Epidemiology & RWDS Johnson & Johnson, United States
Background: Racial disparities in total knee arthroplasty (TKA), a surgical procedure for knee osteoarthritis, have been reported in the United States (US) in prior studies. However, it is unclear whether these disparities are still present.
Objectives: This study aimed to investigate racial disparities in TKA care between Black and White patients in the US from 2000 to 2021.
Methods: We used the PREMIER Healthcare Database, a large US hospital-based, all-payer claims database containing more than 1,000 hospitals, to identify patients (age ≥ 18) who underwent primary TKA between 2000 to 2021. Patients with knee fracture, infection, aseptic loosening, or cancer were excluded. Demographics and comorbidity measured by Elixhauser Comorbidity Index (ECI) between Black and White patients were reported. Racial disparities in extended length of stay (LOS) in the hospital (≥ 3 days), use of computer assisted or robotic surgery, and risk of 3-month readmission were analyzed using multiple logistic regression and adjusting for age, gender, marital status, insurance type, admission year, and preoperative characteristics. A subanalysis on extended LOS was conducted in 2000, 2009 and 2019, the three years that spread across the study period, and using only data from hospitals that continuously participated in Premier’s healthcare alliance for these three years.
Results: A total of 1,841,541 patients were included; 80.3% were White and 7.8% were Black. Compared to Whites, Black patients were more likely to be female, younger, and have a higher ECI. From 2000 to 2021, the fastest growing age group was 18 to 30 for both Black and White patients, followed by age group 31 to 45 for Blacks (7.5%) and age group 81+ for Whites (17.2%). In 2000, LOS averaged 4.17 days for both Black (SD=1.84) and White patients (SD=1.86), with 95% having extended LOS. By 2020, it deceased to 1.19 (SD=1.77) for Blacks and 0.89 (SD=1.28) for Whites. Of these, 25.0% of Black and 18.3% of White patients had extended LOS. In the adjusted model, Black patients were at increased risk of extended LOS (OR=1.36, 95% CI: 1.34, 1.37) compared to Whites. In the subanalysis, this association was significant only in 2019 (OR=1.53, 95% CI: 1.32, 1.76). We found an increased adoption of computer-assisted or robotic surgery (OR=1.12, 95% CI: 1.11, 1.12) and a reduced risk of readmission (OR=0.98, 95% CI: 0.977, 0.978) for every increase in the admission year. Yet, Black patients were less likely to receive computer assisted or robotic TKA (OR=0.79, 95% CI: 0.77, 0.81), and were more likely to be readmitted after TKA (OR=1.11, 95% CI: 1.09, 1.12) compared to White patients.
Conclusions: Racial disparities were still persistent despite multiple targeted efforts. Worse, we found an emerging racial disparity related to extended LOS in TKA care in the US.
