Race, ethnicity and length of hospital stay after knee or hip arthroplasty

Background: Marked racial and ethnic differences exist in the utilization of knee or hip joint replacement in the management of end-stage osteoarthritis. Limited data, however, are available on racial and ethnic differences in hospital length of stay after knee or hip arthroplasty. We sought to examine this issue using the Veterans Administration National database. Methods: We used the Veterans Administration National Surgical Quality Improvement Program database, which contains data on patients who had knee or hip arthroplasty between 1996 and 2000 at 123 hospitals nationwide. We identified 18 263 patients. Race and ethnicity-specific length of stay after hip or knee surgery was summarized using Kaplan-Meier plots. Length of stay after surgery was modeled using a discrete-time proportional odds model, with hospital site as a random effect. Results: In a sample of 11 739 patients with an index total knee arthroplasty, the mean length of hospital stay after surgery was 6.6 days for white patients, 7.6 for African-American patients and 7.1 days for Hispanic patients. In 6524 patients with index total hip arthroplasty, the mean lengths of stay were 7.1, 7.7 and 7.5 respectively. Both African-American and Hispanic patients who had knee arthroplasty were less likely than white patients to be discharged on any given day after the third day. After hip arthroplasty, both African-American and Hispanic patients were less likely to be discharged on any given day than white patients. Conclusions: Compared to white patients, African-American and Hispanic patients had clinically insignificant but statistically significant longer hospitalization after knee and hip arthroplasty.