Abstract
Objectives:
Previous studies have shown racial disparities in the utilization and perioperative metrics of orthopedic procedures. However, it remains unclear if similar disparities exist in rotator cuff repair (RCR). The purpose of this study was to examine trends in racial disparities between white and black patients with inpatient RCR in the United States (US).
Methods:
Admissions for inpatient RCR in 2008-2012 were queried from the Healthcare Cost and Utilization Project National Inpatient Sample. The primary outcome was utilization rate, defined by the number of RCRs normalized to the US population per race and year. The effect of race on utilization and perioperative metrics was assessed using a regression model correcting for race and year, with a race- year interaction term to approximate temporal trends in disparities (alpha=0.05, 1-beta>0.90).
Results:
Overall, 20,363 patients were included in the final analysis, 18,602 identifying as white (91%) and 1,761 (8.6%) as black. On average, white patients undergoing RCR were older (white median=67 [IQR=58-75] years; black median=60 [IQR=52-68] years, P<0.0001) and more likely on Medicare (white: 59%; black: 44%, P<0.0001). Black race was associated with a 6.6/1,000,000 lower utilization rate compared to white race (P<0.0001). Although the utilization gap narrowed over time, this trend was not significant (Ptrend=0.06). Black patients were 4% less likely to be discharged to a facility (P< 0.0001, Ptrend=0.07) and had a 0.23-day longer average length of stay (P=0.047, Ptrend=0.81). When correcting for baseline age and comorbidities, postoperative complications were not significantly different between white and black patients (beta=-2.4%, 95%CI=-13.0%-+8.3%, P=0.60).
Conclusions:
There is a discrepancy in inpatient RCR utilization between white and black patients. Although this disparity appears to be decreasing over time, this trend was not significant. Further studies are warranted to understand causal factors for these differences, that may serve as targets for future public health interventions.
