Racial Disparity in the Perioperative Care for Patients Undergoing Total Knee and Hip Arthroplasty: A Retrospective Propensity-Matched Cohort Study

Abstract

Background: Total joint arthroplasty is an effective treatment for osteoarthritis-related symptoms not resolved with non-surgical therapy. There is a growing body of evidence supporting the use of neuraxial anesthesia for these surgical procedures. We utilized the American College of Surgeons-National Surgical Quality Improvement Program database to study the effects of race on the type of anesthesia and postoperative outcomes in elective total joint replacement surgery.

Methods: We included African-American and White adult patients (age > 18 years) undergoing elective primary total knee or hip arthroplasty under general or neuraxial (spinal or epidural) anesthesia (2005-2013). A 1:3 matched sample of African-American vs. White patients was created based on propensity scores. The differences in anesthetic technique and postoperative complications between the two groups were evaluated before and after matching.

Results: A total of 102,122 patients were included. African-American patients were younger (mean ± standard deviation, 62.08 ± 11.17 vs. 66.37 ± 10.53 years, p < 0.001) and had a lower modified Charlson comorbidity index (CCI) score (3.07 ± 1.39 vs. 3.42 ± 1.33, p < 0.001). General anesthesia was used more commonly in the African-American patients group (64.56 vs. 62.25%, p < 0.001). However, when the two groups were matched, the differences in the type of anesthesia disappeared (odds ratio [OR] 0.96, 95% confidence limits [CL] 0.85-1.08, p = 0.455). African-American patients had a higher rate of 30-day postoperative complications before matching (3.08 vs. 2.20%, p < 0.001) and after matching (3.63 vs. 2.33%) (OR 1.58, 95% CL 1.13-2.21, p = 0.007).

Conclusions: There is no significant difference in the type of anesthesia received for total joint arthroplasty between African-American and White patients; however, there is a disparity in the postoperative outcomes in favor of the White patient group. Further studies needed to explain the reasons for these findings.

Keywords: General anesthesia; Hip arthroplasty; Knee arthroplasty; Neuraxial anesthesia; Postoperative morbidity; Racial disparity; Spinal anesthesia.