How Do Causes of Readmission Following Orthopaedic Surgery Differ Between Races? A Five-Year Analysis of the NSQIP Database

• Published in: Foot & ankle orthopaedics Vol. 8; no. 4
• Main Authors: Bergstein, Victoria E., O’Sullivan, Lucy, Levy, Kenneth H., Vulcano, Ettore, Aiyer, Amiethab A.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-12-2023; Sage Publications Ltd; SAGE Publishing
• Subjects: Orthopedics; Pacific Islander people; Pulmonary embolisms; Race; Surgery; Variance analysis; Outcomes Measures; Clinical Outcomes; Health Care
• ISSN: 2473-0114; 2473-0114
• DOI: 10.1177/2473011423S00317

Category:
Other
Introduction/Purpose:
Previous studies have reported conflicting data regarding 30-day readmission rates between patients of different races following orthopaedic surgery. Differences in specific reasons for 30-day readmission between races following orthopaedic surgery have yet to be explored.
Methods:
The ACS-NSQIP database was utilized to identify patients who underwent orthopaedic surgery and were readmitted within 30 days. Data was collected from 2015–2019, and patients were stratified into one of five race groups: American Indian/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, and White. Analysis of variance (ANOVA) with Bonferroni post-hoc analysis for multiple comparisons was used to compare differences in continuous variables between racial groups. Chi-square analysis with post-hoc analysis of adjusted standardized residuals was used to compare differences in categorical variables between racial groups.
Results:
In total, 975,857 patients from the ACS-NSQIP database were included in the study. All-cause readmission rate was significantly different across races. Asian and Native Hawaiian/Pacific Islander patients had significantly lower readmission rates (2.7% and 2.8%, respectively), whereas Black patients had significantly greater readmission rates (3.9%) (p < 0.01). Black patients had significantly greater readmission rates for deep incisional SSI, wound disruption, renal insufficiency, and pulmonary embolism, and a lower readmission rate for pneumonia compared to other races. Asian patients had a lower readmission rate for pulmonary embolism, wound disruption, superficial incisional SSI, and vein thrombosis requiring therapy.
Conclusion:
Specific causes of 30-day readmission were significantly different between races, with Black patients experiencing higher readmission rates and Asian and Hawaiian/Pacific Islander patients experiencing lower readmission rates overall. Our findings can inform which complications should be more carefully monitored in certain patient populations, and how peri- and post-operative management can be adjusted accordingly.