An Inclusive Analysis of Racial and Ethnic Disparities in Orthopedic Surgery Outcomes

Abstract

Background: Despite increasing attention, disparities in outcomes for Black and Hispanic patients undergoing orthopedic surgery are widening. In other racial-ethnic minority groups, outcomes often go unreported. We sought to quantify disparities in surgical outcomes among Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander patients across multiple orthopedic subspecialties. Materials and Methods: The National Surgical Quality Improvement Program was queried to identify all surgical procedures performed by an orthopedic surgeon from 2014 to 2020. Multivariable logistic regression models were used to investigate the impact of race and ethnicity on 30-day medical complications, readmission, reoperation, and mortality, while adjusting for orthopedic subspecialty and patient characteristics. Results: Across 1,512,480 orthopedic procedures, all patients who were not White were less likely to have arthroplasty-related procedures ( P <.001), and Hispanic, Asian, and American Indian or Alaskan Native patients were more likely to have trauma-related procedures ( P <.001). American Indian or Alaskan Native (adjusted odds ratio [AOR], 1.005; 95% CI, 1.001–1.009; P =.011) and Native Hawaiian or Pacific Islander (AOR, 1.009; 95% CI, 1.005–1.014; P <.001) patients had higher odds of major medical complications compared with White patients. American Indian or Alaskan Native patients had higher risk of reoperation (AOR, 1.005; 95% CI, 1.002–1.008; P =.002) and Native Hawaiian or Pacific Islander patients had higher odds of mortality (AOR, 1.003; 95% CI, 1.000–1.005; P =.019) compared with White patients. Conclusion: Disparities regarding surgical outcome and utilization rates persist across orthopedic surgery. American Indian or Alaskan Native and Native Hawaiian or Pacific Islander patients, who are under-represented in research, have lower rates of arthroplasty but higher odds of medical complication, reoperation, and mortality. This study highlights the importance of including these patients in orthopedic research to affect policy-related discussions. [ Orthopedics . 2024;47(3):e131–e138.]