Patient Race and Surgical Outcomes after Total Knee Arthroplasty: An analysis of a large regional database
Marissa A. Blum, MS, MD,1 Jasvinder A. Singh, MBBS, MPH,2,3,4,5 Gwo-Chin Lee, MD,6 Diane Richardson, PhD, MS,7 Wei Chen, MS, MSE,7 and Said A. Ibrahim, MD, MPH8Knee
Objective
To examine racial differences in surgical complications, mortality and revision rates after total knee arthroplasty.
Methods
We studied patients undergoing primary total knee arthroplasty using 2001–2007 Pennsylvania Health Care Cost Containment Council data. We conducted bivariate analyses to assess the risk of complications: myocardial infarction, venous thromboembolism, wound infections, and failure of prosthesis, and 30-day and one year overall mortality after elective total knee arthroplasty between racial groups. We estimated Kaplan-Meier one and five year surgical revision rates, and fit multivariable Cox proportional hazard models to compare surgical revision by race, incorporating 5 years of follow up. We adjusted for patient age, sex, length of hospital stay, surgical risk of death, type of health insurance, hospital surgical volume and hospital teaching status.
Results
In unadjusted analyses, there were no significant differences by racial group for either overall 30-day or in hospital complication rates, or 30-day and one year mortality rates. Adjusted Cox models incorporating five years of follow up showed an increased risk of revisions for black patients [hazard ratios (95% confidence intervals)]: [1.39 (1.08–1.80)], younger patients [2.30 (1.96–2.69)], and lower risk for female patients [0.81 (0.71–0.92)].
Conclusions
In this sample of patients who underwent knee arthroplasty, we found no significant racial differences in major complication rates or mortality. However, black patients, younger patients, and male patients all had significantly higher rates of revision based on five years of follow up.
Link to article