Scholarlink

Introduction <p>Limited healthcare funding and infrastructure in Puerto Rico (P.R.), a U.S. territory, may restrict care quality for procedures like total knee arthroplasty (TKA). This study examines differences in elective TKA outcomes between traditional Medicare beneficiaries in P.R. and the U.S. mainland.</p> Methods <p>This retrospective cohort study using the Medicare Limited Data Set included patients aged ≥ 65 who underwent inpatient elective primary TKA from 2013 to 2021 in P.R. and in New Mexico, Texas, California, Arizona, or Nevada. To reduce confounding, 1 P.R. patient was matched with up to 2 U.S. mainland Hispanic patients using a propensity score approach. Mixed-effects generalized linear models assessed associations between surgery location and outcomes such as discharge to institutional post-acute care, readmissions, home health services, and surgical complications.</p> Results <p>The matched cohort included 1,143 P.R. patients and 1,899 U.S. mainland patients. Undergoing TKA in P.R. versus the U.S. mainland was associated with higher likelihood of discharge to institutional post-acute care (Risk Ratio 1.35, 95% CI 1.12–1.63; <i>P</i> = 0.002) but lower likelihood of timely home health services (Risk Ratio 0.33, 95% CI 0.26–0.42, <i>P</i> &lt; 0.001). In sensitivity analyses with expanded cohort definitions, associations were identified between undergoing surgery in P.R. and higher likelihood of 30-day and 90-day readmission and 90-day infection.</p> Discussion <p>Financial constraints on hospital resources and limited access to home health services in P.R. may contribute to inefficient care coordination. The observed differences in TKA care processes and outcomes for P.R. versus the U.S. mainland support the need for further research into structural factors that can contribute to health disparities.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Disparities in Total Knee Arthroplasty Outcomes: A Comparison Between Traditional Medicare Beneficiaries in Puerto Rico and the U.S. Mainland

  • 期刊论文

  • 发表日期：

    2026年4月8日

查看全文
  • Rodnell Busigó Torres,
  • James Hong,
  • Calin S. Moucha,
  • Brett L. Hayden,
  • Dencel A. García Vélez,
  • Brocha Z. Stern

摘要

Introduction

Limited healthcare funding and infrastructure in Puerto Rico (P.R.), a U.S. territory, may restrict care quality for procedures like total knee arthroplasty (TKA). This study examines differences in elective TKA outcomes between traditional Medicare beneficiaries in P.R. and the U.S. mainland.

Methods

This retrospective cohort study using the Medicare Limited Data Set included patients aged ≥ 65 who underwent inpatient elective primary TKA from 2013 to 2021 in P.R. and in New Mexico, Texas, California, Arizona, or Nevada. To reduce confounding, 1 P.R. patient was matched with up to 2 U.S. mainland Hispanic patients using a propensity score approach. Mixed-effects generalized linear models assessed associations between surgery location and outcomes such as discharge to institutional post-acute care, readmissions, home health services, and surgical complications.

Results

The matched cohort included 1,143 P.R. patients and 1,899 U.S. mainland patients. Undergoing TKA in P.R. versus the U.S. mainland was associated with higher likelihood of discharge to institutional post-acute care (Risk Ratio 1.35, 95% CI 1.12–1.63; P = 0.002) but lower likelihood of timely home health services (Risk Ratio 0.33, 95% CI 0.26–0.42, P < 0.001). In sensitivity analyses with expanded cohort definitions, associations were identified between undergoing surgery in P.R. and higher likelihood of 30-day and 90-day readmission and 90-day infection.

Discussion

Financial constraints on hospital resources and limited access to home health services in P.R. may contribute to inefficient care coordination. The observed differences in TKA care processes and outcomes for P.R. versus the U.S. mainland support the need for further research into structural factors that can contribute to health disparities.