Primary Total Hip Arthroplasty in Hispanic/Latino Patients: An Updated Nationwide Analysis of Length of Stay, 30-Day Outcomes, and Risk Factors

Abstract

Background: This study explored recent time trends in length of stay (LOS), 30-day outcomes, and risk factors for adverse events (AEs) pertaining to total hip arthroplasty in the Hispanic and Latino population.

Methods: A total of 4107 Hispanic and Latino patients who underwent primary total hip arthroplasty between 2011 and 2017 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Annual trends in LOS and 30-day outcomes (readmission, reoperation, complications, and mortality) were calculated using univariate mixed-effect regression analyses. Risk factors for AEs were determined using multivariate analyses.

Results: Between 2011 and 2017, there was a significant reduction in LOS >2 midnights (67.6% to 29.5%, P < .001) among Hispanic patients, which was similar to that among non-Hispanic white patients and was also accompanied with improvements in comorbidity profiles and shorter operative times. Postoperatively, the annual rates of 30-day outcomes were comparable with those of white patients (P > .05). Chronic kidney disease, the American Society of Anesthesiologists score >2, and chronic steroid use were the strongest independent predictors for AEs.

Conclusions: In the context of historically lower arthroplasty outcomes among the Hispanic and Latino population, current evidence suggests a receding tide, with annual trends showing significantly shorter LOS and comparable overall 30-day outcomes with whites. Patients with chronic kidney disease, the American Society of Anesthesiologists score >2, and chronic steroid use are at the highest risk for developing 30-day AEs.

Keywords: Hip arthroplasty; Hispanic and Latino; Outcomes; Risk factors.

Figure 1

Multivariate logistic regression analysis for development of a 30-d postoperative event. A multivariate logistic regression was used to yield odds ratios for development of a postsurgical event, defined as any combination of a medical complication, surgical complication, mortality, readmission, or reoperation. Patient factors previously demonstrating (P < .05) or approaching significance (P < .10) between the patient groups (Table 1) were controlled for in the regression analysis. Continuous variables (age, BMI, ASA score) were converted to nominal variables based on Youden’s index so as to maximize the discriminative capacity of the cutoff value. BMI, body mass index.