Abstract
Objectives:
Previous investigations have shown decreased utilization and outcomes based on racial status in total knee arthroplasty (TKA) and total shoulder arthroplasty (TSA) cohorts; however, the impact of racial status in patients undergoing shoulder stabilization is poorly understood. The purpose of the current study was to compare how minority status affects surgical timing as well as pre- and intraoperative findings in patients undergoing operative treatment of shoulder instability.
Methods:
As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, 1010 patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative patient-reported outcome scores (PROs), and radiologic and intraoperative findings were then compared between Caucasian and minority patients undergoing surgical shoulder stabilization. In addition, the Economic Innovation Group’s 2017 Distressed Communities Index (DCI) was recorded for each patient’s home zip code. DCI Scores are based on percentages of adults without a high school education, percentage living under the poverty line, unemployment rates, and the overall housing and business climate in a given area. DCI Scores range from 0 to 100, with higher scores indicative of greater economic distress, and DCI Scores ≥ 80 are considered to be highly distressed regions. Continuous variables were compared between groups using two-tailed independent t-tests and categorical variables were compared using chi-square tests.
Results:
Of the 1010 patients, 988 patients (97.8%) had complete preoperative and intraoperative data. The cohort was largely Caucasian (851, 86.1%), with 137 minority patients, including 71 African American, 49 Asian, 13 Native American, and 4 Hawaiian or Pacific Islander. DCI scores were significantly worse for minority patients than Caucasians (39.4 vs. 28.1, p<0.001), as were preoperative expectations (p=0.02). A greater percentage of minority patients had 2 or more dislocations (69.1% vs. 57.7%, p=0.01) which corresponded with more frequent articular cartilage lesions (64.2% vs. 51.0%, p=0.004).
Conclusion:
Racial minorities were found to have more preoperative dislocations, higher rates of articular cartilage lesions, and worse preoperative expectations. DCI scores were lower in the racial minority group; however, this was not found to be an independent predictor of pre- and/or intraoperative findings. These findings identify a need to identify barriers in an action to reduce racial disparities in the treatment of shoulder instability.