Background

Although racial and ethnic disparities in total joint arthroplasty (TJA) have been thoroughly described, only a few studies have sought to determine exactly where along the care pathway these disparities are perpetuated. The purpose of this study was to investigate disparities in TJA utilization occurring after patients who had diagnosed hip or knee osteoarthritis were referred to a group of orthopaedic providers within an integrated academic institution.

Methods

A retrospective, multi-institutional study evaluating patients with diagnosed hip or knee osteoarthritis was conducted between 2015 and 2019. Information pertaining to patient demographics, timing of clinic visits, and subsequent surgical intervention was collected. Utilization rates and time to surgery from the initial clinic visit were calculated by race, and logistic regressions were performed to control for various demographic as well as health related variables.

Results

White patients diagnosed with knee osteoarthritis were significantly more likely to receive total knee arthroplasty (TKA) than Black and Hispanic patients, even after adjusting for various demographic variables (Black patients: odds ratio [OR] = 0.63, 95% CI = 0.55-0.72, P = .002; Hispanic patients: OR = 0.69, 95% CI = 0.57-0.83, P = .039). Similar disparities were found among patients diagnosed with hip osteoarthritis who underwent total hip arthroplasty (THA; Black patients: OR = 0.73, 95% CI = 0.60-0.89, P = <.001; Hispanic patients: OR = 0.72, 95% CI = 0.53-0.98, P <.001). There were no differences in time to surgery between races (P > .05 for all).

Conclusion

In this study, racial and ethnic disparities in TJA utilization were found to exist even after referral to an orthopaedic surgeon, highlighting a critical point along the care pathway during which inequalities in TJA care can emerge. Similar time to surgery between White, Black, and Hispanic patients suggest that these disparities in TJA utilization may largely be perpetuated before surgical planning while patients are deciding whether to undergo surgery. Further studies are needed to better elucidate which patient and provider-specific factors may be preventing these patients from pursuing surgery during this part of the care pathway.

Level of Evidence

Level IV.

中文翻译：

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骨科手术转诊后全关节置换术的利用：确定护理途径中的差异

背景

尽管已对全关节置换术 (TJA) 中的种族和民族差异进行了详尽描述，但只有少数研究试图确定这些差异在护理过程中的确切位置。本研究的目的是调查在将诊断为髋关节或膝关节骨关节炎的患者转介给综合学术机构内的一组骨科提供者后，TJA 使用的差异。

方法

2015 年至 2019 年期间进行了一项评估已诊断为髋关节或膝关节骨关节炎患者的回顾性多机构研究。收集了有关患者人口统计学、就诊时间和随后手术干预的信息。从初次就诊到手术的利用率和时间按种族计算，并进行逻辑回归以控制各种人口统计学和健康相关变量。

结果

被诊断患有膝骨关节炎的白人患者接受全膝关节置换术 (TKA) 的可能性明显高于黑人和西班牙裔患者，即使在调整了各种人口统计学变量后也是如此（黑人患者：比值比 [OR] = 0.63，95% CI = 0.55-0.72 ,  P = .002；西班牙裔患者：OR = 0.69，95% CI = 0.57-0.83，  P = .039）。在接受全髋关节置换术（THA；黑人患者：OR = 0.73，95% CI = 0.60-0.89，  P = < .001；西班牙裔患者：OR = 0.72，95% CI = 0.53-0.98，  P <.001)。种族之间的手术时间没有差异（所有P > .05）。

结论

在这项研究中，即使在转诊给整形外科医生后，也发现 TJA 使用方面的种族和民族差异存在，突出了护理路径中的一个关键点，在此期间 TJA 护理中可能出现不平等现象。白人、黑人和西班牙裔患者的手术时间相似表明，当患者决定是否接受手术时，TJA 使用的这些差异可能在手术计划之前就已经存在了。需要进一步的研究来更好地阐明哪些患者和提供者的特定因素可能会阻止这些患者在这部分护理过程中进行手术。

证据等级

第四级。