In:
Anesthesiology, Ovid Technologies (Wolters Kluwer Health), ( 2023-08-31)
Abstract:
Various studies have demonstrated racial disparities in perioperative care and outcomes. We hypothesize that among lower extremity total joint arthroplasty (TJA) patients, Evidence Based Perioperative Practice (EBPOP) utilization increased over time amongst all racial groups, and that standardized EBPOP care protocols resulted in reduction of racial disparities and improved outcomes. Methods We analyzed 3,356,805 lower extremity TJA patients from the Premier Healthcare database. The exposure of interest was race (White, Black, Asian, other). Outcomes were EBPOP adherence (8 individual care components; & gt;80% of these implemented was defined as ‘high EBPOP’), any major complication (including acute renal failure, delirium, myocardial infarction, pulmonary embolism, respiratory failure, stroke, or in-hospital mortality), in-hospital mortality, and prolonged length of stay (LOS). Results EBPOP adherence rate has increased over time and was associated with reduced complications across all racial groups. However, utilization amongst Black patients was below that for White patients between 2006 to 2021, (OR 0.94, 95% CI: 0.93, 0.95) (45.50% vs 47.90% on average). Independent of whether EBPOP components were applied, Black patients exhibited higher odds of major complications (1.61 (95% CI 1.55, 1.67) with high EBPOP; 1.43 (95% CI 1.39, 1.48) without high EBPOP), mortality (1.70 (95% CI 1.29, 2.25) with high EBPOP; 1.29 (95% CI 1.10, 1.51) without high EBPOP), and prolonged LOS (1.45 (95% CI 1.42, 1.48) with high EBPOP; 1.38 (95% CI 1.37, 1.40) without high EBPOP) compared to White patients. Conclusions EBPOP utilization in lower extremity joint arthroplasty has been increasing over the last decade. However racial disparities still exist with Black patients consistently having lower odds of EBPOP adherence. Black patients (compared to the White patients) exhibited higher odds of composite major complications, mortality, and prolonged LOS, independent of EBPOP use, suggesting that EBPOP did not impact racial disparities regarding especially Black patients in this surgical cohort.
Type of Medium:
Online Resource
ISSN:
0003-3022
,
1528-1175
DOI:
10.1097/ALN.0000000000004755
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2023
detail.hit.zdb_id:
2016092-6
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