Disparities in postoperative total shoulder arthroplasty outcomes between Black and White patients

Background: Despite the rise in surgical volume for total shoulder arthroplasty (TSA) procedures, racial disparities exist in outcomes between White and Black populations. The purpose of this study was to compare 30-day postoperative complication rates between Black and White patients following TSA.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent TSA between 2015 and 2019. Patient demographics and comorbidities were compared between cohorts using bivariate analysis. Multivariate logistic regression, adjusted for all significantly associated patient demographics and comorbidities, was used to identify associations between Black or African American race and postoperative complications.

Results: A total of 19,733 patients were included in the analysis, 18,669 (94.6%) patients in the White cohort and 1064 (5.4%) patients in the Black or African American cohort. Demographics and comorbidities that were significantly associated with Black or African American race were age 40-64 years (P < .001), body mass index ≥40 (P < .001), female gender (P < .001), American Society of Anesthesiologists classification ≥3 (P < .001), smoking status (P < .001), non-insulin and insulin dependent diabetes mellitus (P < .001), hypertension requiring medication (P < .001), disseminated cancer (P = .040), and operative duration ≥129 minutes (P = .002). Multivariate logistic regression identified Black or African American race to be independently associated with higher rates of readmission (odds ratio: 1.42, 95% confidence interval: 1.05-1.94; P = .025).

Conclusion: Black or African American race was independently associated with higher rates of 30-day readmission following TSA.