背景:全关节置换术(TJA)在改善与健康相关的生活质量方面是成功的。然而,由于可修改和不可修改的因素,文献中的结果各不相同。可修改的因素包括体重指数(BMI),营养,烟草使用。不可改变的风险因素包括年龄,种族,性别,和社会经济地位。先前的文献集中在下肢关节成形术的使用方面的种族差异。这项研究的目的是确定种族和性别对院内并发症发生率的影响,逗留时间,以及与主要TJA相关的费用。
方法:该回顾性队列利用了2016年至2019年国家住院患者样本(NIS)的复杂调查数据。使用国际疾病分类-10程序代码(ICD-10PCS)的右髋关节,左臀部,右膝,和左膝TJA的初步总数为2,660,280名患者。排除标准是双侧关节成形术和伴随的单侧髋和膝关节炎。主要并发症定义为急性心肌梗死,心脏骤停,肺栓塞,成人呼吸窘迫综合征,中风,震惊,和败血症。赔率比(OR)和β系数根据年龄进行了调整,性别,主要付款人,医院区域,医院教学现状,和年份。使用美国劳工统计局报告的消费者物价指数数据对总费用进行了通货膨胀调整。
结果:共有2,589,510名患者符合我们的纳入标准;87.6%,5.9%,4.8%,1.4%,0.3%的人是“白人”,\'黑色\',\'西班牙裔\',\'亚洲人,或者太平洋岛民,和“美洲原住民”,由国家(全国)住院样本(NIS)变量“RACE”定义。与白人相比,黑人个体的主要并发症发生率明显更高(0.87%vs.0.74%,OR1.25,p值=0.0004)。与白人相比,黑人和西班牙裔个体的轻微并发症发生率明显更高(6.39%vs.4.12%,比值比(OR)1.61,p值<0.0001;4.68%与4.12%,OR1.17,p值<0.0001)。黑色,西班牙裔,亚洲或太平洋岛民,美洲原住民留下了,平均而言,比白人多0.33、0.19、0.19和0.25天(2.78、2.54、2.55、2.56与2.37天,p<0.0001)。这些统计学上显著的差异都没有超过两天确立的最小临床重要差异。黑色,西班牙裔,亚洲或太平洋岛民患者的费用比白人患者高5,751美元,18,656美元和12,119美元(72,122美元,85,027美元,78,490美元和59,297美元vs.$66,371,p≤0.0165)。美国原住民患者的收费比白人患者低7,074美元(59,297美元与66,371美元,p<0.0001)。
结论:黑人和西班牙裔TJA患者的并发症发生率可能高于白人TJA患者。种族组之间停留时间的差异可能不会影响结果。西班牙裔患者收到的费用明显高于白人患者,在控制了不可改变的危险因素后,美国原住民患者收到的费用明显少于白人患者。解决费用差异可能会减少与TJA相关的国家总成本负担。本研究强调需要进一步研究与种族和性别相关的医疗保健结果。
BACKGROUND: Total joint arthroplasty (TJA) is successful in improving health-related quality of life. However, outcomes vary in the literature due to modifiable and non-modifiable factors. Modifiable factors consist of body mass index (BMI), nutrition, and tobacco use. Non-modifiable risk factors include age, race, sex, and socioeconomic status. Prior literature has focused on racial disparities in terms of the utilization of lower extremity arthroplasty. The purpose of this study is to determine the effect of race and sex on the in-hospital complication rate, length of stay, and charges associated with primary TJA.
METHODS: This retrospective cohort utilized complex survey data from the National Inpatient Sample (NIS) between 2016 and 2019. The use of the International Classification of Disease-10 Procedure Codes (ICD-10 PCS) for right hip, left hip, right knee, and left knee TJA yielded a preliminary total of 2,660,280 patients. The exclusion criteria were bilateral arthroplasty and concomitant unilateral hip and knee arthritis. Major complications were defined as acute myocardial infarction, cardiac arrest, pulmonary embolism, adult respiratory distress syndrome, stroke, shock, and septicemia. Odds ratio (OR) and beta coefficients were adjusted for age, sex, primary payer, hospital region, hospital teaching status, and year. Total charges were adjusted for inflation using the Consumer Price Index data reported by the US Bureau of Labor Statistics.
RESULTS: A total of 2,589,510 patients met our inclusion criteria; 87.6%, 5.9%, 4.8%, 1.4%, and 0.3% of people were \'White\', \'Black\', \'Hispanic\', \'Asian, or Pacific Islander\', and \'Native American\', as defined by the National (Nationwide) Inpatient Sample (NIS) Variable \'RACE\'. Black individuals experienced a significantly greater major complication rate compared to White individuals (0.87% vs. 0.74%, OR 1.25, p-value = 0.0004). Black and Hispanic individuals experienced a significantly greater minor complication rate compared to White individuals (6.39% vs. 4.12%, odds ratio (OR) 1.61, p-value < 0.0001; 4.68% vs. 4.12%, OR 1.17, p-value < 0.0001). Black, Hispanic, Asian or Pacific Islander, and Native American individuals stayed, on average, 0.33, 0.19, 0.19, and 0.25 days longer than White individuals (2.78, 2.54, 2.55, 2.56 vs. 2.37 days, p<0.0001). None of these statistically significant differences exceeded the established minimal clinically important difference of two days. Black, Hispanic, and Asian or Pacific Islander patients were charged $5,751, $18,656, and $12,119 more than White patients ($72,122, $85,027, $78,490, and $59,297 vs. $66,371, p ≤ 0.0165). Native American patients were charged $7,074 less than White patients ($59,297 vs. $66,371, p < 0.0001).
CONCLUSIONS: Black and Hispanic TJA patients may have higher complication rates than White TJA patients. The differences in length of stay between race groups may not affect outcomes. Hispanic patients received significantly more charges than White patients, and Native American patients received significantly fewer charges than White patients after controlling for non-modifiable risk factors. Addressing the charge disparities may reduce the total national cost burden associated with TJA. The present study highlights the need for further studies on healthcare outcomes related to race and sex.