Study finds racial, gender disparities in utilization of outpatient shoulder arthroplasty
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Key takeaways:
- There were significant disparities in outpatient shoulder arthroplasty rates for white patients vs. Black, Hispanic or Asian patients.
- White patients and men had increased use rates vs. women and Black patients.
Published results showed Black patients had a 30% decreased odds of undergoing outpatient total shoulder arthroplasty vs. white patients, while women had a 25% decreased odds of undergoing the procedure vs. men.
Catherine J. Fedorka MD, and colleagues from the Avant-Garde Health and Codman Shoulder Society Value-Based Care Group used Medicare fee-for-service claims and enrollment data from 2020 to 2022 to assess utilization rates of outpatient vs. inpatient TSA. According to the study, researchers identified 168,504 TSA procedures during the study period.
Researchers found TSA utilization rates per 1,000 beneficiaries were 2.3 for white patients, 0.8 for Black patients, 0.6 for Hispanic patients and 0.3 for Asian patients. Researchers noted 25.6% of outpatient TSAs were performed on white patients, while 20.4% of outpatient TSAs were performed on Black patients.
Researchers found Black patients had a 30% decreased odds of undergoing outpatient TSA vs. white patients (OR = 0.70), while women had a 25% decreased odds of undergoing outpatient TSA vs. men (OR = 0.75).
“Racial and gender disparities continue to be an issue for shoulder arthroplasties after the adoption of outpatient TSAs,” the researchers wrote in the study.
Perspective
Back to TopAjith K. Subhash, MD, and Ronald A. Navarro, MD
The Avant-Garde Health group and the Codman Shoulder Society have teamed to perform studies with members providing data in a collaborative way. In this study, the group of authors aimed to understand whether utilization of outpatient total shoulder arthroplasty differed across gender and racial groups. They found that racial and gender disparities continue to be an issue for shoulder arthroplasties after the adoption of outpatient TSAs. The authors identified a limitation of this study being that it excluded patients who underwent shoulder arthroplasty at ASCs but did not comment on how this may have influenced the results.
Given the recent emphasis on efficient high-quality health care delivery and evidence to suggest outpatient shoulder arthroplasty is safe in appropriately selected patients, the authors of this paper likely excluded a significantly growing number of patients. Moreover, the patient population at ASCs are usually individuals that are younger (pre-Medicare) and have insurance with better accessibility to care, are of higher socioeconomic status and have less comorbidity burden. Lastly, a prior study has demonstrated that Black patients have been less likely to have surgery at ASCs after controlling for age, comorbidities, health insurance status and various other factors.
Extrapolating from this prior literature, if this study or future studies can capture these patients, it might reveal an even larger significant racial disparity between Black and white patients receiving outpatient TSAs. The reasons for these presumed imbalances in care might be a future focus for these and other research teams.
References:
Brolin TJ, et al. J Shoulder Elbow Surg. 2017;doi:10.1016/j.jse.2016.07.011.
Janeway MG, et al. JAMA Surg. 2020;doi:10.1001/jamasurg.2020.3318.
Strope SA, et al. BMC Health Serv Res. 2009;doi:10.1186/1472-6963-9-121.
Winter A. Health Aff (Millwood). 2003;doi:10.1377/hlthaff.22.6.68.
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