To What Extent Does Race/Ethnicity Change Length of Stay?

A new study from Albert Einstein College of Medicine in Bronx, New York, has tackled this title question and found that race/ethnicity is NOT an independent risk factor for extended length of stay (LOS). However, health risk factors endemic to urban, socioeconomically disadvantaged patient cohorts were risk factors for extended length of stay.

Their work, “Black and Hispanic Patients Do Not Stay Longer After Primary Total Knee Arthroplasty: Results From an Urban Center Serving a Predominantly Minority Cohort,” appears in the April 1, 2022, edition of The Journal of the American Academy of Orthopaedic Surgeons.

Chief of Joint Replacement at the Albert Einstein College of Medicine, Sun Jin Kim, M.D. told OTW, “Race- and ethnicity-based disparities have been identified in overall healthcare and orthopaedic care for several decades. However, the disparities became evident as crucial determinants for health outcomes over the last few years during the COVID pandemic as Black and Hispanic/Latino patients in the Bronx were disproportionately affected.”

“Clinical studies usually do not have enough representation from minority groups. Our healthcare system serves predominantly Black and/or Hispanic/Latino patients so we have a unique opportunity to study whether the race- and ethnicity-based disparities affect the length of stay after primary total joint arthroplasty.”

Co-investigator Zeynep Seref-Ferlengez, Ph.D., who is also with Albert Einstein, noted “The secondary reason is the shift of total knee arthroplasty (TKA) surgeries from inpatient surgeries to outpatient surgeries. In 2018, The Centers for Medicare & Medicaid Services (CMS) removed the TKA procedures from Medicare’s Inpatient-Only List which allowed TKA procedures to be performed on an inpatient or outpatient basis. Therefore, minimizing postoperative length of stay has been an important target to decrease healthcare costs associated with longer stays.”

Adding detail about the study time period was Yoav Zvi, a resident researcher in the Orthopaedic Surgery Department at Montefiore Health System. “The dates have been selected due to the history of our institute, it is a single institute study, and The Center for Joint Replacement Surgery at Montefiore was established in 2016. We did not want to include 2020 as COVID-19 has shifted the hospital discharge policies so we only included the cases over the years of 2016 to 2019.”

“Most importantly,” said Dr. Kim to OTW, “we demonstrated that minority race/ethnicity is not an independent risk factor for prolonged hospital length of stay after primary TKA, but we found several associated risk factors for prolonged length of stay after TKA in an urban, socioeconomically disadvantaged, predominantly minority patient cohort.”

“Some risk factors for prolonged length of hospital stay were found as nonhome discharge, low socio-economic status, smoking, obesity, and health comorbidities. Last, 30-day hospital re-admission did not differ between racial/ethnic groups, as well as normal and prolonged length of stay groups. In contrast to previous reports, our study showed that Black and Hispanic patients were less likely to have prolonged LOS after primary TKA, after adjusting for known associated risk factors.

“Black and Hispanic patients are often underrepresented in orthopaedic surgery and joint arthroplasty literature; as such, the previously discussed findings that show race and ethnicity as independent risk factors for prolonged length of stay may not be truly representative of their postoperative outcomes and LOS. The current findings highlight the need to further investigate the role of race/ethnicity on length of stay after primary TKA using large-scale, randomized controlled trials with equally represented patient cohorts.”