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Disparities in unilateral knee replacement surgery have been well documented, with lower use and higher complication rates among African American patients. While previous studies had focused on single knee replacement surgery, researchers at the Hospital for Special Surgery (HSS) set out to determine whether racial variations exist for bilateral same-day knee replacement as well.
“In our retrospective analysis, we found that the bilateral knee replacement utilization rate was much lower in African American patients than in white patients,” said Bella Mehta, MBBS, rheumatologist at HSS. “On the other hand, although African Americans who have unilateral knee replacement have been shown to have higher in-hospital complication rates than white patients, this pattern was not consistent for bilateral knee replacement during the time frame we have. studied”.
He presented the findings on November 9 at the American College of Rheumatology annual meeting, which took place virtually.
Dr. Mehta and colleagues compiled information from the National Inpatient Sample (NIS) database – Healthcare Cost and Utilization Project (HCUP) from 2007 to 2016. They examined trends in the use and key hospital complication rates of unilateral knee replacement. compared to bilateral national level in patients aged 50 years or older.
Investigators assessed racial differences over time, adjusting for age, gender and comorbidities; hospital variables, including hospital volume, number of beds, region, and teaching status; and community-level factors, such as median household income.
From 2007 to 2016, 5.5 million unilateral and 276,000 bilateral knee replacements were performed in the United States. The percentage of bilateral knee replacements dropped from 5.53% in 2007-2008 to 4.03% in 2015-16.
The researchers found that African Americans were far less likely to undergo a double knee replacement than white patients during the years they analyzed. Rates of hospital complications varied over the study period, with no significant differences between African American and white patients.
To explain the results of the complication rate study, Dr. Mehta said there may be a more rigorous patient selection process when considering candidates for bilateral knee replacement on the same day. As for the smaller number of African Americans having the bilateral procedure, he said doctors might offer it less often to African American patients or they may choose not to have the procedure.
“Because the complication rate for bilateral knee replacement is not higher for African American patients, health care professionals should work to provide access to all appropriate patients,” said Dr. Mehta. He noted that future studies could take a closer look at the patient selection process or evaluate the role of an individual’s health insurance plan in using the bilateral procedure.
“As we strive to achieve health equity for our patients, we need to understand the challenges they face in accessing care, as well as the variance in their outcomes,” said Michael Parks, MD, orthopedic surgeon at HSS and author of the study. “Our ultimate goal is to provide the same quality of care for everyone.”
Source:
Hospital for Special Surgery
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