Racial disparities in arthroscopic rotator cuff repair: an analysis of utilization and perioperative outcomes
Jacob A. Linker, Christopher T. Eberlin, Sara Naessig, Samuel S. Rudisill, Michael P. Kucharik, Nathan J. Cherian, Matthew J. Best, Scott D. Martin
Abstract
BackgroundThere remains a paucity of literature addressing racial disparities in utilization and perioperative metrics in arthroscopic rotator cuff repair procedures.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was utilized to evaluate patients undergoing arthroscopic rotator cuff repair from 2010 – 2019. Baseline demographics, utilization trends, and perioperative measures including adverse events, operative time, length of hospital stay, days from operation to discharge, and readmission were analyzed.ResultsOf 42,443 included patients, 38,090 (89.7%) were White and 4,353 (10.3%) were Black or African American. Black or African American patients had a significantly higher percentage of diabetes mellitus (23.6% vs. 15.6%), smoking (16.9% vs. 14.8%), congestive heart failure (0.3% vs. 0.1%), and hypertension (59.2% vs. 45.9%). Additionally, logistic regression showed that Black or African American patients had increased odds of longer operative time [adjusted rate ratio (ARR) 1.07, 95% confidence interval (CI) 1.05-1.08] and time from operation to discharge [ARR 1.19, 95% CI 1.04-1.37]. Disparities in relative utilization decreased as the proportion of Black or African American patients undergoing arthroscopic rotator cuff repair increased (7.4% in 2010 vs. 10.4% in 2019) compared to White patients (ptrend < .0001).ConclusionRacial disparities exist regarding baseline comorbidities and perioperative metrics in arthroscopic rotator cuff repair. Further investigation is needed to fully understand and address causes of these inequalities to provide equitable care. There remains a paucity of literature addressing racial disparities in utilization and perioperative metrics in arthroscopic rotator cuff repair procedures. The American College of Surgeons National Surgical Quality Improvement Program database was utilized to evaluate patients undergoing arthroscopic rotator cuff repair from 2010 – 2019. Baseline demographics, utilization trends, and perioperative measures including adverse events, operative time, length of hospital stay, days from operation to discharge, and readmission were analyzed. Of 42,443 included patients, 38,090 (89.7%) were White and 4,353 (10.3%) were Black or African American. Black or African American patients had a significantly higher percentage of diabetes mellitus (23.6% vs. 15.6%), smoking (16.9% vs. 14.8%), congestive heart failure (0.3% vs. 0.1%), and hypertension (59.2% vs. 45.9%). Additionally, logistic regression showed that Black or African American patients had increased odds of longer operative time [adjusted rate ratio (ARR) 1.07, 95% confidence interval (CI) 1.05-1.08] and time from operation to discharge [ARR 1.19, 95% CI 1.04-1.37]. Disparities in relative utilization decreased as the proportion of Black or African American patients undergoing arthroscopic rotator cuff repair increased (7.4% in 2010 vs. 10.4% in 2019) compared to White patients (ptrend < .0001). Racial disparities exist regarding baseline comorbidities and perioperative metrics in arthroscopic rotator cuff repair. Further investigation is needed to fully understand and address causes of these inequalities to provide equitable care.