Study: Black patients receive transfusions for TJA at higher rates than white patients
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Key takeaways:
- Black patients had higher rates of transfusion for TJA compared with white patients despite similar hemoglobin levels.
- Overall, transfusion rates declined during the study period from 2013 to 2021.
Despite a decline in transfusion rates from 2013 to 2021, published results showed Black patients who underwent total knee arthroplasty had significantly higher rates of transfusion compared with white patients.
To assess potential disparities in transfusion rates for total joint arthroplasty between Black and white patients, researchers retrospectively analyzed data from 5,435 patients who underwent TKA and 2,105 patients who underwent THA from 2013 to 2021. According to the study, 67.1% of patients who underwent TKA and 69.8% of patients who underwent THA were white. Overall, transfusion rates were 2.9% in the TKA group and 3.1% in the THA group.
Researchers noted transfusion rates declined during the study period. “However, the rate of decline is not proportional across demographic groups, and being Black is associated with a significantly increased risk of transfusion for TKA patients but not for THA patients,” the investigators wrote. Black patients had higher rates of transfusion for TKA (5.1% vs. 1.8%) and THA (4.1% vs. 2.7%) compared with white patients despite similar hemoglobin levels between the groups.
After performing multivariable logistic regression and adjusting for potential confounders, researchers found Black patients were at a higher risk for transfusion within 5 days of surgery.
“Racial differences in transfusion might point toward disparities in care and should be studied to understand why this disparity in transfusion rates over time still exists,” the researchers wrote in the study. “It is paramount that we understand what factors are involved in the decision to transfuse to improve patient outcomes in future TJA cases,” they concluded.
Perspective
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As someone who has spent much of my career evaluating disparities at the health system level, it is heartening to see that electronic health records have become robust enough to add important clinical detail to large-scale statistical analyses. In the case of Shelby H. Meckstroth, MPH, and colleagues, the addition of hemoglobin and creatinine levels to a study of health disparities in joint arthroplasty allows for a more reliable estimate of the isolated effect of race and/or ethnicity. As a result, we can see that Black patients were more likely to receive a transfusion after joint arthroplasty than their white counterparts independent of clinical characteristics, such as comorbidities, hemoglobin levels or creatine levels. This suggests that wide racial disparities continue to exist despite clear clinical practice guidelines. Whether this reflects conscious or unconscious bias (or an, as yet, unmeasured or unmeasurable bit of clinical nuance) remains to be investigated by future study teams.
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