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Black Patients More Likely to Be Readmitted After Hip, Knee Replacement Surgery

Authors present ‘troubling finding’ at orthopedic meeting

A new study presented at the 2015 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that black and Hispanic patients were 62% and 50%, respectively, more likely to be readmitted to the hospital within 30 days after total joint replacement (TJR) surgery compared with white patients. In addition, Medicaid patients were 40% more likely to be readmitted to the hospital than were patients with private insurance.

Disparities in the provision of health care services have long been documented, including the fact that black patients receive hip and total knee replacement at rates nearly 40% less than that of white patients despite having comparable or higher rates of osteoarthritis — a leading cause of joint deterioration.

In the new study, researchers analyzed five years of demographic (including race/ethnicity), clinical, and billing data from nearly 53,000 patients admitted to Connecticut hospitals for TJR from 2008 to 2012. The patients’ average age was 67 years, and most of the patients were white (87%), female (61%), and covered by Medicare (57% percent).

The overall 30-day readmission rate for patients was 5.2%. The most common reasons for readmission were postoperative infection (8%), infection and inflammatory reactions due to the internal joint prosthesis (6%), hematoma complications during a procedure (3%), and dislocation of the prosthetic joint (3%). Other study findings included the following:

  • Readmission rates were 83.5 per thousand for black patients, 78.9 per thousand for Hispanic patients, and 53.3 per thousand for white patients.
  • A longer hospital stay was significantly associated with increased odds of readmission.
  • When controlling for co-morbidities and the type of insurance coverage, the readmission rate dropped 44% for Hispanic patients and 38% for black patients. Black patients remained significantly more likely than white patients to be readmitted following surgery, after controlling for co-morbidities.
  • Patients covered by Medicare were 30% more likely to be readmitted within 30 days following discharge compared with patients covered by private insurance, and Medicaid patients were 40% more likely.

Recent research using national Medicare data suggests that community-based factors, such as the availability of general practitioners in the area, may be as important or more important than hospital factors in determining readmission rates, and that patients may have few options other than hospital care for both urgent and non-urgent conditions related to their surgery or other conditions.

“Using an all-payer database, our study shows that black patients who undergo total knee replacement may have poorer outcomes,” said lead author Courtland Lewis, MD. “After controlling for two key variables implicated in race and ethnic disparities in hospital readmission — preoperative co-morbidities and the type of insurance coverage — black patients still have a 35% higher likelihood of all-cause, 30-day readmission compared with white patients.”

“Our ongoing research in this area is focused on other factors, such as the patient’s connection to primary care and patient-provider communication, that may explain this troubling finding,” Lewis added.

Source: Medical Xpress; March 26, 2015.

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