• Ahmad Elsharydah, Ahmed S Embabi, Abu Minhajuddin, and Girish P Joshi.
• Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA. ahmad.elsharydah@utsouthwestern.edu.
• J Racial Ethn Health Disparities. 2018 Jun 1; 5 (3): 632-637.

BackgroundTotal joint arthroplasty is an effective treatment for osteoarthritis-related symptoms not resolved with non-surgical therapy. There is a growing body of evidence supporting the use of neuraxial anesthesia for these surgical procedures. We utilized the American College of Surgeons-National Surgical Quality Improvement Program database to study the effects of race on the type of anesthesia and postoperative outcomes in elective total joint replacement surgery.MethodsWe included African-American and White adult patients (age > 18 years) undergoing elective primary total knee or hip arthroplasty under general or neuraxial (spinal or epidural) anesthesia (2005-2013). A 1:3 matched sample of African-American vs. White patients was created based on propensity scores. The differences in anesthetic technique and postoperative complications between the two groups were evaluated before and after matching.ResultsA total of 102,122 patients were included. African-American patients were younger (mean ± standard deviation, 62.08 ± 11.17 vs. 66.37 ± 10.53 years, p < 0.001) and had a lower modified Charlson comorbidity index (CCI) score (3.07 ± 1.39 vs. 3.42 ± 1.33, p < 0.001). General anesthesia was used more commonly in the African-American patients group (64.56 vs. 62.25%, p < 0.001). However, when the two groups were matched, the differences in the type of anesthesia disappeared (odds ratio [OR] 0.96, 95% confidence limits [CL] 0.85-1.08, p = 0.455). African-American patients had a higher rate of 30-day postoperative complications before matching (3.08 vs. 2.20%, p < 0.001) and after matching (3.63 vs. 2.33%) (OR 1.58, 95% CL 1.13-2.21, p = 0.007).ConclusionsThere is no significant difference in the type of anesthesia received for total joint arthroplasty between African-American and White patients; however, there is a disparity in the postoperative outcomes in favor of the White patient group. Further studies needed to explain the reasons for these findings.

36 keywords...

hide…