The views expressed herein are those of the authors and do not represent those of the Department of Veterans Affairs.
Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty†
Article first published online: 30 SEP 2005
Copyright © 2005 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 52, Issue 10, pages 3143–3151, October 2005
How to Cite
Ibrahim, S. A., Stone, R. A., Han, X., Cohen, P., Fine, M. J., Henderson, W. G., Khuri, S. F. and Kwoh, C. K. (2005), Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty. Arthritis & Rheumatism, 52: 3143–3151. doi: 10.1002/art.21304
- Issue published online: 30 SEP 2005
- Article first published online: 30 SEP 2005
- Manuscript Accepted: 29 JUN 2005
- Manuscript Received: 7 FEB 2005
- Robert Wood Johnson Foundation
- Arthritis Foundation, Western Pennsylvania Branch
- VA Health Services Research and Development Office
- Robert Wood Johnson Foundation Harold Amos Faculty Development Award
The utilization of joint arthroplasty for knee or hip osteoarthritis varies markedly by patient race/ethnicity. Because of concerns about surgical risk, black patients are less willing to consider this treatment. There are few published race/ethnicity-specific data on joint arthroplasty outcomes. The present study was undertaken to examine racial/ethnic differences in mortality and morbidity following elective knee or hip arthroplasty.
Using information from the Veterans Administration National Surgical Quality Improvement Program database, data on 12,108 patients who underwent knee arthroplasty and 6,703 patients who underwent hip arthroplasty over a 5-year period were analyzed. Racial/ethnic differences were determined using prospectively collected data on patient characteristics, procedures, and short-term outcomes. The main outcome measures were risk-adjusted 30-day mortality and complication rates.
Adjusted rates of both non–infection-related and infection-related complications after knee arthroplasty were higher among black patients compared with white patients (relative risk [RR] 1.50, 95% confidence interval [95% CI] 1.08–2.10 and RR 1.42, 95% CI 1.06–1.90, respectively). Hispanic patients had a significantly higher risk of infection-related complications after knee arthroplasty (RR 1.64, 95% CI 1.08–2.49) relative to otherwise similar white patients. Race/ethnicity was not significantly associated with the risk of non–infection-related complications (RR 0.97, 95% CI 0.68–1.38 in blacks; RR 1.18, 95% CI 0.60–2.30 in Hispanics) or infection-related complications (RR 1.27, 95% CI 0.91–1.78 in blacks; RR 1.22, 95% CI 0.63–2.36 in Hispanics) after hip arthroplasty. The overall 30-day mortality was 0.6% following knee arthroplasty and 0.7% following hip arthroplasty, with no significant differences by race/ethnicity observed for either procedure.
Although absolute risks of complication are low, our findings indicate that, after adjustment, black patients have significantly higher rates of infection-related and non–infection-related complications following knee arthroplasty, compared with white patients. In addition, adjusted rates of infection-related complications after knee arthroplasty are higher in Hispanic patients than in white patients. Such differences between ethnic groups are not seen following hip arthroplasty. These groups do not appear to differ significantly in terms of post-arthroplasty mortality rates.