Assessing Gender Disparities in Total Joint Arthroplasty from the National Inpatient Sample Database

Abstract

INTRODUCTIONDisparities in the health care system signify potential risks for vulnerable groups whose needs are not appropriately met. Several studies established basic inequalities between men and women with respect to health services available, including total joint arthroplasty (TJA) procedures‐. TJA has been successful in treating end‐stage arthritis, resulting in a steady increase in demand for the procedure over the last decades. This project aimed to assess and compare the differences in preoperative risk factors and postoperative outcomes between male and female patients undergoing TJA.METHODSOur study utilized de‐identified patient data from the National Inpatient Sample (NIS) database from 2006–2011. The NIS records ICD‐9‐CM codes to identify granular data involved in a patient’s in‐hospital stay. The data was stratified to create two cohorts of male and female patients that underwent primary TJA. We further stratified each cohort by matching for additional comorbidities using the Elixhauser Comorbidity Index. Postoperative and economic outcomes were measured for matched cohorts, respectively. Descriptive statistics were obtained, and univariate analyses using t‐tests and chi‐squared statistics were conducted for continuous and categorical data, respectively. Odds ratios with respective confidence intervals were calculated to assess the association of gender and post‐TJA complications.RESULTSFemale TJA patients present at a later age for TJA procedures, and present with comorbidities that result in them having greater odds of experiencing in‐hospital complications compared to male TJA patients. Furthermore, female TJA patients have a longer average inpatient stay than male TJA patients, incurring more than average total charges. Male TJA patients are more likely to be discharged home as compared to female TJA patients.CONCLUSIONUnderstanding these factors will help address the unmet needs and concerns of both genders regarding TJA, ensuring that qualified patients are able to access the necessary procedures for pain relief and functional improvementSupport or Funding InformationNone