Disparities in Elective and Nonelective Total Hip Arthroplasty

Hi, my name is Greg Bennis and I'm a current medical student at LSU in New Orleans and I'm going to be discussing our Research which looks at disparities among Hip Arthroplasty.

So Total hip arthroplasty is indicated electively for management of Hip Arthritis and non-electively for management of femoral neck fractures. Studies have shown differences in outcomes between THA whether the Surgery was due to Arthritis of the Hip or Hip fracture. Non-elective THA has been associated with increased risk of inhospital mortality and post-op complications, as well as longer operation time and length of stay.

Studies have also shown utilization disparities among different populations, mainly among minority groups, utilization of elective surgeries. However, these findings are mixed. Few studies consist of or distinguish between elective and non-elective Surgery cohorts.

The objectives of our study are first, to examine the relationship between various factors and utilization of Primary THA and second, to explore how these factors influence revision rates based on elective or non-elective Surgery indication.

Our study utilized the ReachNet database, which consists of multiple healthcare partners across Louisiana and Texas. Patients were selected by a THA code um between 2014 and 2020 and classified as non-elective if they had an associated femoral neck ICD code, and elective if they had an Osteoarthritis of the Hip ICD code.

This gave us just over 14,000 patients.

Of the 14,000 patients, roughly 1/3 underwent THA non-electively for Hip fracture.

Breaking things down demographically by each uh respected cohort. We found that, um, most of our study was female.

White

And had public insurance.

Address objective number one of utilization of Primary THA, we performed multivariable logistic regression and found that non-elective THA was associated with Hispanic ethnicity, female, significant alcohol use.

Trailer individuals and as you can see with this relationship, all lower BMI groups compared to the 40 plus BMI group have increased odds of non non-elective THA with the significance of the odds ratio increasing as the BMI group decreases.

Older age and increased CCI were also associated with non-elective THA.

Next, to address objective number 2 of utilization of Revision surgery, we performed similar analysis and found an increased odds of Revision surgery within 3 years among those who had Surgery for Hip fracture.

About 12% of the non-elective cohort underwent re-operation compared to roughly 7% of the elective cohort.

Significant alcohol use and smoking were also associated with increased odds of Revision surgery.

On the Other hand, black patients and older patients were less likely to undergo reoperation within 3 years. Interestingly, BMI had no association with the odds of Revision surgery.

There are several limitations of our study due to the retrospective nature and use of a large database. We were unable to assess patient-physician relationships as well as health literacy. Certainly understanding or being aware of elective procedures can influence the decision to have it done. Additionally, we are unable to assess the role that implicit and explicit biases could have played. It is well established that these can directly impact disparities and equality within the, the setting of Orthopedics.

Lastly, we were unable to quantitatively assess variables such as alcohol with the number of drinks per day, or smoking with pack years, and so forth.

What's the takeaway?

Our study first our study found that Hispanic patients disproportionately undergo THA for Fracture.

Shows the importance of health literacy and patient education. Studies within the orthopedic setting have shown that the use of translators can can result in less in-depth conversations and result in decreased utilization of elective surgeries. Maybe this could have played into our findings. Additionally, studies have shown increasing Fracture incidence trends in Hispanic populations, and our study further emphasizes the potential need for Fracture prevention strategies among this group.

Second, we found that black patients are less likely to undergo Revision surgery, and this could indicate the disparity that arises in access to orthopedic care from Primary to Revision surgery. Recent studies with the Kaiser Permanente carere Group in the VA.

Showed that access to care and quality, um whenever they're standardized across race and ethnicity disparities in THA outcomes may be eliminated. Our study, which consisted of different insurance types, healthcare groups, and hospital Protocols, supports these, uh, findings by showing a decreased rate of revision among black patients. The problem could be due to access of care with system-wide Protocols rather than biological constructs.

Lastly, our study found that smokers and alcohol use are associated with increased reoperation within 3 years of the Primary Surgery.

And this shows the importance of counseling patients as these can serve as modifiable Risk factors for Revision surgery risk.

In conclusion, I hope I have showed how demographic demographic and social factors impact utilization of Primary and revision THA Surgery.

Any disparities within the arthroplasty setting need to be addressed.

And the future direction of the study is to examine trends on a national scale.

You're listening to my presentation.