Inflexible eligibility criteria for lower extremity joint arthroplasty disproportionately discourages surgeons from operating on non-Hispanic black patients and patients of lower socioeconomic status, according to a study in Clinical Orthopaedics and Related Research.
Cost-containment strategies may discourage surgeons from operating on patients with preexisting risk factors, such as high body mass index, high hemoglobin A1c or smoking cigarettes.
The researchers assessed data from 21,294 adults aged 50 years or older from the 1999 to 2014 National Health and Nutrition Examination Survey.
Excluding patients with a BMI greater than 35 kilograms per square meter led to:
- Lower arthroplasty eligibility for non-Hispanic black patients compared with non-Hispanic white patients
- Lower arthroplasty eligibility for women than men
- Reduced eligibility for patients with an annual household income of less than $45,000
- Reduced eligibility for patients with a high school degree or less versus those with greater educational attainment
Requiring patients to have a HbA1c level of less than 8 percent resulted in reduced eligibility for:
- Non-Hispanic black and Hispanic patients than non-Hispanic white individuals
- Individuals of lower socioeconomic status versus those of higher socioeconomic status
- Patients with a high school degree or less versus those greater educational attainment
Excluding smokers reduced arthroplasty eligibility for:
- Non-Hispanic black people versus non-Hispanic white patients
- Individuals of lower socioeconomic status compared to those of higher socioeconomic status
- Those with a high school degree or less versus those with greater educational attainment
"We do not advocate performing elective surgery for patients with multiple, uncontrolled medical comorbidities," the study authors wrote. However, they suggested that many patients with BMI values greater than 35 kilograms per square meter may be reasonable candidates for surgery. "We discourage across-the-board cutoff parameters in these domains because such cutoffs will worsen current racial-ethnic, gender-based and socioeconomic disparities and limit access to an operation that can improve quality of life," the researchers concluded.