Patient Race Significantly Impacts Postoperative Outcome in Total Hip Arthroplasty Patients

Abstract

Introduction: Frailty negatively impacts outcomes after total hip arthroplasty (THA). However, whether the influence of frailty is equitable among patients of different races is unknown. This study assesses the influence of race among frail patients undergoing THA. Methods: The National Surgical Quality Improvement Program database was queried (2015-2019) for patients undergoing primary THA. First, patients were divided into categories based on race, then stratified by frailty using mFI-5. Frailty was determined with mFI-5 ≥2 points. Chi-squared and logistic regression analyses (odds ratio (OR), 95% confidence interval (CI)) were performed to compare associations between different races and postoperative complication and resource use. Results: Of the 136,661 THA patients evaluated, Black or African-American patients (n = 13066) had the highest incidence of postoperative complication (7%) and overall increased resource use (p < 0.01). Black or African-American patients also had the highest proportion of frail patients (20.3%, p < 0.001). With White frail patients as reference group, frail Black or African-American patients were 2.5x more likely to experience deep vein thrombosis (OR:2.58, CI:1.53-4.36), 2x more likely to have a pulmonary embolism (OR:2.04, CI:1.1-3.8), and 1.4x more likely for non-home discharge (p < 0.001). Frail Asian patients were 2.5x more likely to suffer from a superficial surgical site infection (OR:2.52, CI:1.01-6.32) compared with frail White patients. Conclusion: The findings of this study demonstrate that frailty may impact patients of different races to a varying degree. This data demonstrates that frail Black or African-American THA patients as a high-risk group. This calls for heightened awareness of race-specific risks in management of THA patients.