Association between race, post operative outcomes and costs for inpatient and outpatient total joint arthroplasty

Background: While factors like readmissions and costs have been compared between care settings for total joint arthroplasty, little research has analyzed readmission and cost differentials stratified by patient characteristics within each care setting. This study will unveil such differences with regard to race and co-morbidity status. Methods: Retrospective binary-logistic-regression and OLS regression were employed on de-identified inpatient and outpatient orthopedic surgical data gathered from an academic medical center from 2016-2020. Data elements included surgical setting, covariates (age, gender, race, obesity, smoking status), Elixhauser comorbidity indices, surgical times, and cost. Results: African American (AA) inpatients had significantly greater odds of return to hospital (7 day, 30 day, 90 day) when compared to Caucasian inpatients (P<0.01-0.05). AA inpatients less than 65 yr old had significantly increased odds of returning to the hospital and getting readmitted (7 day, 30 day) when compared to AA inpatients older than 65 and all Caucasian inpatients (P<0.05). Asian inpatients had significantly greater odds of 90 day return (P<0.05). AA outpatients had significantly greater odds of 30 day return when compared to Caucasian outpatients. Age and time spent in the OR directly correlated with increased costs (P<0.05, P<0.01). Increased comorbidities correlated with increased costs only for inpatients (P<0.05). Conclusion: All AA patients, but specifically those less than 65 yr of age, experience increased readmissions and returns to hospital following the same procedure when compared to their Caucasian counterparts. Medicaid patients experience greater costs, Medicare-Managed patients experienced decreased costs. Co-morbidites were directly related to costs in the inpatient setting.