Background Studies of racial disparities in total ankle arthroplasty are lacking.
Objectives Our objective was to study the racial disparities in total ankle arthroplasty (TAA) utilization and outcomes.
Methods We used the Nationwide Inpatient Sample (NIS) to study the time-trends. Race was categorized as White and Black. Utilization rates were calculated for the U.S. general population per 100,000. Hospital length of stay, discharge disposition and mortality after TAA were assessed. We used the Cochran Armitage trend test to assess time-trends from 1998 to 2011 and chi-square test to compare TAA utilization. We used analysis of variance or chi-squared test to compare the characteristics of Whites and Blacks undergoing TAA and logistic regression to compare mortality, length of stay and discharge to home vs medical facility.
Results The mean ages for Whites undergoing TAA were 62 years and for Blacks was 52 years. Significant racial disparities were noted in TAA utilization rates (/100,000) in 1998, 0.14 in Whites vs. 0.07 in Blacks (p<0.0001; 2-fold) and in 2011, 1.17 in Whites vs. 0.33 in Blacks (p<0.0001; 4-fold). Racial disparities in TAA utilization increased significantly from 1998 to 2011 (p<0.0001). There was a trend towards statistical significance in the length of hospital stay in Blacks vs. Whites (52.9% vs. 44.3% with length of hospital stay higher than the median; p=0.08). Differences in the proportion discharged to an inpatient medical facility after TAA, 16% Blacks vs. 13% Whites, were not significant (p=0.47)
Conclusions This study demonstrated significant racial disparities with lower TAA utilization and suboptimal outcomes in Blacks compared to Whites. Further studies are needed to understand the mediators of these disparities and to assess whether these mediators can be targeted to reduce racial disparities in TAA.
Acknowledgements This material is the result of work supported by the resources and use of facilities at the Birmingham VA Medical Center, Alabama, USA. J.A.S. is also supported by grants from the Agency for Health Quality and Research Center for Education and Research on Therapeutics (CERTs), National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS), National Institute of Aging (NIA) and National Cancer Institute (NCI).
Disclosure of Interest J. Singh Grant/research support from: takeda, savient, Consultant for: takeda, Savient, Allergan, Regeneron, R. Ramachandran: None declared