Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis.
Journal
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
ISSN: 2474-7661
Titre abrégé: J Am Acad Orthop Surg Glob Res Rev
Pays: United States
ID NLM: 101724868
Informations de publication
Date de publication:
01 Mar 2024
01 Mar 2024
Historique:
received:
02
01
2024
accepted:
17
01
2024
medline:
4
3
2024
pubmed:
4
3
2024
entrez:
4
3
2024
Statut:
epublish
Résumé
Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery. The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes. Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures. Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.
Sections du résumé
BACKGROUND
BACKGROUND
Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery.
METHODS
METHODS
The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes.
RESULTS
RESULTS
Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures.
CONCLUSIONS
CONCLUSIONS
Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.
Identifiants
pubmed: 38437055
doi: 10.5435/JAAOSGlobal-D-24-00013
pii: 01979360-202403000-00004
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.
Références
McCormack R, Michels R, Ramos N, Hutzler L, Slover JD, Bosco JA: Thirty-day readmission rates as a measure of quality: Causes of readmission after orthopedic surgeries and Accuracy of administrative data. J Healthc Manag 2013;58:64-77.
Bernatz JT, Tueting JL, Anderson PA: Thirty-day readmission rates in orthopedics: A systematic review and meta-analysis. PLOS ONE 2015;10:e0123593.
Bovonratwet P, Shen TS, Ast MP, Mayman DJ, Haas SB, Su EP: Reasons and risk factors for 30-day readmission after outpatient total knee arthroplasty: A review of 3015 cases. J Arthroplasty 2020;35:2451-2457.
Dailey EA, Cizik A, Kasten J, Chapman JR, Lee MJ: Risk factors for readmission of orthopaedic surgical patients. J Bone Joint Surg Am Vol 2013;95:1012-1019.
Adogwa O, Elsamadicy AA, Mehta AI, Cheng J, Bagley CA, Karikari IO: Racial disparities in 30-day readmission rates after elective spine surgery: A single institutional experience. Spine 2016;41:1677-1682.
Blum MA, Singh JA, Lee GC, Richardson D, Chen W, Ibrahim SA: Patient race and surgical outcomes after total knee arthroplasty: An analysis of a large regional database. Arthritis Care Res 2013;65:414-420.
Chen SA, White RS, Tangel V, Nachamie AS, Witkin LR: Sociodemographic characteristics predict readmission rates after lumbar spinal fusion surgery. Pain Med 2020;21:364-377.
Hunter T, Yoon RS, Hutzler L, et al.: No evidence for race and socioeconomic status as independent predictors of 30-day readmission rates following orthopedic surgery. Am J Med Qual 2015;30:484-488.
Metcalfe D, Olufajo OA, Zogg CK, et al.: Unplanned 30-day readmissions in orthopaedic trauma. Injury 2016;47:1794-1797.
Aseltine RHJ, Wang W, Benthien RA, et al.: Reductions in race and ethnic disparities in hospital readmissions following total joint arthroplasty from 2005 to 2015. J Bone Joint Surg Am Vol 2019;101:2044-2050.
Cusano A, Venugopal V, Gronbeck C, Harrington MA, Halawi MJ: Where do we stand today on racial and ethnic health inequities? Analysis of primary total knee arthroplasty from a 2011-2017 national database. J Racial Ethn Health Disparities 2021;8:1178-1184.
Hinman AD, Chan PH, Prentice HA, Paxton EW, Okike KM, Navarro RA: The association of race/ethnicity and total knee arthroplasty outcomes in a universally insured population. J Arthroplasty 2020;35:1474-1479.
Martsolf GR, Barrett ML, Weiss AJ, et al.: Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty. J Bone Joint Surg Am Vol 2016;98:1385-1391.
Shiloach M, Frencher SK, Steeger JE, et al.: Toward robust information: Data quality and inter-rater reliability in the American College of surgeons national surgical quality improvement program. J Am Coll Surg 2010;210:6-16.
Williams DR, Rucker TD: Understanding and addressing racial disparities in health care. Health Care Financ Rev 2000;21:75-90.
Torain MJ, Maragh-Bass AC, Dankwa-Mullen I, et al.: Surgical disparities: A comprehensive review and new conceptual framework. J Am Coll Surg 2016;223:408-418.
Cooper LA, Hill MN, Powe NR: Designing and evaluating interventions to eliminate racial and ethnic disparities in health care. J Gen Intern Med 2002;17:477-486.
Martin JR, Wang TY, Loriaux D, et al.: Race as a predictor of postoperative hospital readmission after spine surgery. J Clin Neurosci 2017;46:21-25.
Xu AL, Raad M, Shafiq B, Srikumaran U, Aiyer AA: Racial disparities in early adverse events and unplanned readmission after open fixation of fractures distal to the knee. OTA Int Open Access J Orthop Trauma 2023;6:e233.
Tsai TC, Orav EJ, Joynt KE: Disparities in surgical 30-day readmission rates for Medicare beneficiaries by race and site of care. Ann Surg 2014;259:1086-1090.
Zakai NA, McCLURE LA: Racial differences in venous thromboembolism. J Thromb Haemost 2011;9:1877-1882.
White RH, Keenan CR: Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 2009;123suppl 4:S11-S17.
Zelenty W, Sama A: Venous thromboembolism and pulmonary embolism in spine surgery: Incidence, prevention, and management. Semin Spine Surg 2022;34:100923.
Burgess DJ, Crowley-Matoka M, Phelan S, et al.: Patient race and physicians’ decisions to prescribe opioids for chronic low back pain. Soc Sci Med 2008;67:1852-1860.
Cuevas AG, O'Brien K, Saha S: African American experiences in healthcare: “I always feel like I’m getting skipped over.”. Health Psychol 2016;35:987-995.
Dy CJ, Lane JM, Pan TJ, Parks ML, Lyman S: Racial and socioeconomic disparities in hip fracture care. J Bone Jt Surg Am 2016;98:858-865.
Fang J, Zhang Z, Ayala C, Thompson Paul AM, Loustalot F: Cardiovascular health among non-hispanic Asian Americans: NHANES, 2011-2016. J Am Heart Assoc 2019;8:e011324.
Mulhern KC, Wahl TS, Goss LE, et al.: Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer. J Surg Res 2017;218:23-28.
Ye J, Rust G, Baltrus P, Daniels E: Cardiovascular risk factors among asian Americans: Results from a national health survey. Ann Epidemiol 2009;19:718-723.
Amirian H, Torquati A, Omotosho P: Racial disparity in 30-day outcomes of metabolic and bariatric surgery. Obes Surg 2020;30:1011-1020.
Bergés IM, Kuo YF, Ostir GV, Granger CV, Graham JE, Ottenbacher KJ: Gender and ethnic differences in rehabilitation outcomes after hip-replacement surgery. Am J Phys Med Rehabil 2008;87:567-572.
Cohen PN, Casper LM: In whose home? Multigenerational families in the United States, 1998-2000. Sociological Perspect 2002;45:1-20.
Nafilyan V, Islam N, Ayoubkhani D, et al.: Ethnicity, household composition and COVID-19 mortality: A national linked data study. J R Soc Med 2021;114:182-211.
Subramaniam S, Carolan MT: “We keep the traditions going”: Intergenerational transmission of cultural identities among Asian Indian multigenerational households, in Johnson DJ, Chuang SS, Glozman J, eds. Re/Formation and Identity: The Intersectionality of Development, Culture, and Immigration. Advances in Immigrant Family Research. Berlin, Springer International Publishing, 2022, 45-6110.1007/978-3-030-86426-2_3.
Schoenfeld AJ, Tipirneni R, Nelson JH, Carpenter JE, Iwashyna TJ: The influence of race and ethnicity on complications and mortality after orthopedic surgery: A systematic review of the literature. Med Care 2014;52:842-851.
Paxton EW, Inacio MCS, Singh JA, Love R, Bini SA, Namba RS: Are there modifiable risk factors for hospital readmission after total hip arthroplasty in a US healthcare system? Clin Orthop Relat Res 2015;473:3446-3455.
Ling K, Leatherwood W, Fassler R, Burgan J, Komatsu DE, Wang ED: Disparities in postoperative total shoulder arthroplasty outcomes between Black and white patients. JSES Int 2023;7:842-847.
Fu MC, Young K, Cody E, Schairer WW, Demetracopoulos CA, Ellis SJ: Most readmissions following ankle fracture surgery are unrelated to surgical site issues: An analysis of 5056 cases. Foot Ankle Orthop 2017;2:247301141769525.
Liu JW, Ahn J, Raspovic KM, et al.: Increased rates of readmission, reoperation, and mortality following open reduction and internal fixation of ankle fractures are associated with diabetes mellitus. J Foot Ankle Surg 2019;58:470-474.
National Diabetes Statistics Report 2020. Estimates of diabetes and its burden in the United States.
Giglia MD, DeRussy A, Morris MS, et al.: Racial disparities in length-of-stay persist even with no postoperative complications. J Surg Res 2017;214:14-22.
Molina CS, Thakore RV, Blumer A, Obremskey WT, Sethi MK: Use of the national surgical quality improvement program in orthopaedic surgery. Clin Orthop Relat Res 2015;473:1574-1581.
Chan JJ, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Vulcano E: Surgeon type and outcomes after inpatient ankle arthrodesis and total ankle arthroplasty: A retrospective cohort study using the nationwide premier healthcare claims database. J bone Joint Surg Am Vol 2019;101:127-135.