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March 18, 2022Clinical Orthopaedics and Related ResearchOpen Access

CORR Synthesis: How Might the Preoperative Management of Risk Factors Influence Healthcare Disparities in Total Joint Arthroplasty?

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Why the study?

Preoperative risk management programs may enforce strict cutoffs without robust care pathways, potentially worsening healthcare disparities in total joint arthroplasty for racial and ethnic minorities, women, and lower-income patients.

Do preoperative risk management programs influence healthcare disparities in adult patients undergoing elective total joint arthroplasty?

Population

Adult patients undergoing elective TJA across 24 included studies

Comparison

Preoperative risk management programs and healthcare disparities across race, ethnicity, gender, income, and insurance

Design

Systematic review of 24 articles

Key result

A review of 24 studies found that while preoperative risk management programs reduce length of stay and complications after total joint arthroplasty, strict cutoffs may worsen healthcare disparities.

Authors

CDChloe C. DlottDWDaniel H. Wiznia

Discussion

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Member takes

Overview

Strict cutoffs risk widening disparities in total joint arthroplasty access; challenges unnuanced optimization without equity safeguards.

Structured PICO

Do preoperative risk management programs influence healthcare disparities in adult patients undergoing elective total joint arthroplasty?

P
Population
A review of 24 studies evaluating the impact of preoperative risk management programs and healthcare disparities on postoperative outcomes in adult patients undergoing elective total joint arthroplasty.
I
Intervention
Preoperative risk management programs (including preoperative cutoffs and specialist referrals)
O
Outcome
Healthcare disparities in postoperative outcomes including length of stay, readmissions, emergency department visits, complications, and discharge disposition

Strict preoperative risk cutoffs for total joint arthroplasty may inadvertently widen healthcare disparities by restricting access for vulnerable populations unless accompanied by robust care navigation.

Limitations

  • Citation chaining is not as comprehensive as a systematic review, meaning some relevant studies may have been missed.
  • Many included studies were conducted at an institutional level and lacked sufficient sample size for subanalyses by race, gender, income, or insurance type.
  • Patient income was often not included in the analyzed studies.

Cite This Study

Dlott et al. (2022) conducted a review in Total Joint Arthroplasty (n=24). Preoperative risk management programs vs. Standard care or no program was evaluated on Readmissions, emergency department visits, length of stay, discharge disposition, and postoperative complications. A review of 24 studies found that while preoperative risk management programs reduce length of stay and complications after total joint arthroplasty, strict cutoffs may worsen healthcare disparities.

synapsesocial.com/papers/6a5cc2dcd50e1fe7bb03495fhttps://doi.org/10.1097/corr.0000000000002177
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