Table 1.

Description of studies found in literature search related to disparities in care

Study	Total number of patients	Procedure	Study type	Study purpose	Conclusions	Mentions healthcare disparities?	Mentions preoperative risk factor management?
Disparities in care for women
Cheah et al. [14]	5,048,371	THA and TKA	Retrospective study using the NIS	Provide a population-based epidemiologic assessment of preoperative risk factors and gender disparities among patients undergoing TJA	Women present later for TJA, have more comorbidities, more in-hospital complications, and are less likely to be discharged home compared with men.	Yes (gender)	No
Disparities in care for patients from racial and ethnic minority backgrounds
Cusano et al. [18]	262,954	TKA	Retrospective study using ACS-NSQIP	Investigated associations between race and ethnicity and procedure utilization, LOS, 30-day readmissions, and postoperative complications	Black race compared with White race was associated with more readmissions, longer LOS, and incidence of any postoperative complication. Hispanic/Latino ethnicity compared with non-Hispanic White patients was associated with longer LOS and incidence of any postoperative complication.	Yes (race and ethnicity)	No
Sheth et al. [62]	11,574	THA	Retrospective study using ACS-NSQIP	Investigated recent trends in procedure utilization, comorbidity profiles, hospital LOS, 30-day mortality, readmissions, and complications, and risk factors for AEs among patients identifying as Black	Between 2011 and 2017, there have been improvements in procedure utilization, comorbidity profiles, and LOS; however, no differences in 30-day mortality, readmissions, or complications.	Yes (race)	Yes, discussed that preoperative management of risk factors is a target for intervention
Trivedi et al. [70]	19,496	TKA	Retrospective study using ACS-NSQIP	Analyzed trends in mortality, LOS, postoperative surgical and medical complications, and readmissions after TKA and developed a preoperative risk stratification model for Black patients undergoing TKA	Overall, there have been improvements in annual trends in LOS, proportion of inpatient stays > 2 days, and postoperative surgical complications for Black patients after TKA. The study also developed a risk stratification nomogram for Black patients.	Yes (race)	Yes, discussed management of risk factors preoperatively such as anemia and tobacco use
Venugopal et al. [73]	12,767	TKA	Retrospective study using ACS-NSQIP	Analyzed trends in utilization, comorbidity profiles, hospital LOS, 30-day mortality, readmissions, and complications among patients identifying as Hispanic/Latino	Between 2011 and 2017, there have been improvements in procedure utilization, comorbidity profiles, and LOS, but the incidence of any postoperative event and inpatient stay > 2 days have increased.	Yes (race and ethnicity)	Yes, discussed that preoperative management of risk factors could be helpful for this patient population
Disparities in care based on race, gender, comorbidity burden, and insurance type
SooHoo et al. [67]	138,399	THA	Retrospective study using statewide California data	Studied patient and provider factors that are associated with complications after THA	The authors found that the incidence of 90-day complications after THA, including dislocations and revision surgeries, was associated with treatment at low-volume hospitals, Black race, and patients with more comorbidities.	Yes (race)	No
Weiner et al. [75]	41,832	THA	Retrospective study using Illinois COMPdata administrative database	Investigated patient characteristics associated with LOS and discharge disposition	The authors found that female gender, compared with male gender was associated with LOS > 3 days and nonhome discharge. Black race, compared with White race was associated with LOS > 5 days and nonhome discharge. Medicaid insurance was associated with LOS > 3 days, LOS > 5 days, and nonhome discharge.	Yes (gender, race, and insurance type)	Yes, mentioned that preoperative risk management programs may cause patients to be excluded
White et al. [76]	274,851	THA	Retrospective study using California, Florida, and New York SIDs	Investigated differences in readmission by insurance payer, race or ethnicity, and income	The authors found that Medicaid insurance compared with private insurance, Black race compared with White race, and lower incomes compared with higher incomes are associated with higher readmissions.	Yes (race, income, and insurance type)	Yes, discussion mentioned addressing modifiable risk factors preoperatively
Disparities in care based on insurance type
Maman et al. [47]	922,819	TKA	Retrospective study using New York, Florida, Maryland, Kentucky, and California SIDs	Investigated whether insurance type is associated with in-hospital mortality and morbidity after TKA	Medicaid insurance is associated with an increased odds of mortality and complications after TKA.	Yes (insurance type and race)	No
Veltre et al. [72]	1,352,505	TKA	Retrospective study using the NIS	Investigated the association between patient insurance type and in-hospital complications after TKA	The authors found that public insurance (Medicare or Medicaid) is associated with more medical complications and greater mortality; non-White race compared with White race is associated with complications after TKA.	Yes (insurance type and race)	Yes, discussion mentioned that preoperative risk factor management is important to reduce modifiable risk factors before surgery
Xu et al. [77]	295,572	THA	Retrospective study using California, Florida, and New York SIDs	Investigated the relationship between insurance type and in-hospital mortality, postoperative complications, readmissions, and LOS after THA	The authors found that Medicaid insurance compared with private insurance is associated with increased in-hospital mortality, cardiovascular and infectious complications, readmissions, and LOS	Yes (insurance type and race)	No
Disparities in care, other
Holbert et al. [32]	11,451	THA and TKA	Retrospective institutional study	Identified associations between living in a medically underserved area and LOS, discharge disposition, readmissions, costs, and ED visits	The authors found that living in a medically underserved area was associated with longer LOS, nonhome discharge, increased costs, and increased ED visits	Yes (medically underserved communities)	Yes, stated that patients were cared for in a coordinated Joint Replacement Center and received preoperative medical evaluations

NIS = National Inpatient Sample; ACS-NSQIP = American College of Surgeons National Surgical Quality Improvement Program; AEs = adverse events; SID = State Inpatient Database; ED = emergency department.