Is Race a Factor in Postop Orthopedic Care?

Rather alarming new multicenter research indicates that African American knee replacement patients could be receiving poorer quality postop care than their Caucasian counterparts. The study, “Association of Race/Ethnicity With Hospital Discharge Disposition After Elective Total Knee Arthroplasty,” was published in the October 30, 2019 edition of JAMA Open Network.

The study authors collected data from 107,000 knee replacement surgeries from a regional database and found that African American patients were significantly more likely than white patients to be discharged to an inpatient rehabilitation or skilled nursing facility (as opposed to receiving postop care at home).

Those African American patients under the age of 65 were more likely to be readmitted to the hospital within 90 days of a knee replacement. The study included patients who had elective knee replacement surgery in the state of Pennsylvania between 2012 and 2015.

This research was conducted by investigators from Hospital for Special Surgery in New York City (Michael Parks, M.D.), the University of Alabama at Birmingham (Jasvinder Singh, M.B.B.S., M.P.H.), the University of Pennsylvania (Yong Chen, Ph.D.) and Weill Cornell Medicine/New York Presbyterian Hospital (Said A. Ibrahim, MD, M.P.H.).

“Total knee replacement is one of the most common and successful elective procedures performed in adults with arthritis, and previous studies have described racial disparities in outcomes,” said Michael Parks, M.D., an orthopedic surgeon involved in the study concept and design and in drafting the manuscript. “For this study, we wanted to determine if there was an association of race/ethnicity with discharge destination and hospital readmission after this procedure.”

“The analytic sample, which included a total of 107,768 patients, found that African American patients were 2.5- to 5-times more likely than white patients to be discharged to an inpatient rehabilitation facility or skilled nursing facility rather than to their home. In 2015, almost 50 percent of African American patients were discharged to a skilled nursing facility,” said Dr. Parks.

Among patients younger than 65, African American patients also had 1.3-times higher odds of 90-day hospital readmission, although there was no difference in hospital readmission rates in patients who were 65 or older. Discharge destination to an inpatient or skilled nursing facility for rehabilitation was associated with increased odds of hospital readmission.

Asked about the most useful finding, co-author Said Ibrahim, M.D., M.P.H., M.B.A., chief of the Division of Healthcare Delivery Science and Innovation at Weill Cornell Medicine, told OTW, “Widely reported disparities in access/utilization of elective knee and hip replacement also involve post-care disparities that may have implications for patient outcomes.”

As for what stands in the way of advancing this issue, he noted, “We need payment incentives that advance better decision-making on post-op care/rehab discharge planning focusing on minority patients and patients from low SES [socioeconomic status] communities.”