Racial Disparities in Total Ankle Arthroplasty: An Analysis of a Large National Dataset

Abstract

Category: Ankle; Other Introduction/Purpose: A significant body of literature exists that documents the racial/ethnic disparities in orthopedics. Previous studies have looked at racial disparities in total ankle arthroplasty and have shown concerning TAA utilization rates. One such study detailed a two fold difference in rate per 100,000 of 0.14 in Whites vs. 0.07 in Blacks in 1998, which continued to worsen and by 2011 the utilization rate was 1.17 in Whites vs. 0.33 in Blacks, a 4-fold difference. The purpose of this study was to update the literature and analyze the utilization rates of TAA by race as well as to detect any differences in outcomes between the groups through the most updated data available in the National Surgical Quality Improvement Program (NSQIP) database. Methods: A retrospective cohort study was performed utilizing the National Surgical Quality Improvement Program (NSQIP) database. Patients were identified for inclusion using the Current Procedural Terminology (CPT) codes 27700 and 27702, corresponding to arthroplasty ankle and arthroplasty ankle with implant, respectively. All patient's with known race were included, non-Hispanic White, non-Hispanic Black, Asian, Native American, and Hispanic. A total of 1164 patients met inclusion criteria for this study. Results: A total of 1164 patients with known race undergoing TAA from 2012-2018 were included in this analysis. Of these patients 1051 (90.3%) were non-Hispanic white (White), and 113 (9.7%) were non-Hispanic Black, Asian, Native American, and Hispanic (Non-White). The mean patient age for White patients was 63.7 years, compared to 55.3 years for Non-White patients which was statistically significant. (p-value <0.01). There was a similar distribution of males and females in each group, and smoking status and presence of diabetes mellitus was similar in both groups. In the listed postoperative complications, non-white patients were at no increased risk of developing superficial wound infection, deep wound infection, PE, DVT, requiring a blood transfusion, requiring another operation, or requiring readmission to the hospital within 30 days. Conclusion: Based on this large national data set, between the years 2012 and 2018 there was nearly 10-fold more non-Hispanic white patient's undergoing TAA when compared to other racial/ethnic groups. This unfortunately highlights the continued, if not worsening racial disparities present in TAA. Additionally, no differences were found in post-operative outcomes based on racial or ethnic group. This indicates that different racial or ethnic groups are doing no worse post-operatively from TAA when compared to Whites.