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Lex JR, Pincus D, Paterson JM, Widdifield J, Chaudhry H, Fowler R, Hawker G, Ravi B. Association between immigration status and total knee arthroplasty outcomes in Ontario, Canada: a population-based matched cohort study. Can J Surg 2024; 67:E228-E235. [PMID: 38729643 PMCID: PMC11090629 DOI: 10.1503/cjs.013723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients. METHODS We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups. RESULTS We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period (p < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, p < 0.001), infection (p < 0.001), death (p = 0.004), and surgical complications (p < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation (p < 0.001) and less likely to present to the emergency department (p < 0.001) than Canadian-born patients. CONCLUSION Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty.
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Affiliation(s)
- Johnathan R Lex
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
| | - Daniel Pincus
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
| | - J Michael Paterson
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
| | - Jessica Widdifield
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
| | - Harman Chaudhry
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
| | - Rob Fowler
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
| | - Gillian Hawker
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
| | - Bheeshma Ravi
- From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Lex, Pincus, Chaudhry, Ravi); the Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ont. (Lex); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Chaudhry); ICES, Toronto, Ont. (Paterson, Widdifield); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Paterson, Widdifield, Fowler, Hawker); the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Fowler, Ravi); the Department of Medicine, University of Toronto, Toronto, Ont. (Hawker)
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Krupic F, Manojlovic S, Custovic S, Fazlic M, Sadic S, Kärrholm J. Influence of immigrant background on the outcome of total hip arthroplasty: better outcome in 280 native patients in Bosnia and Herzegovina than in 449 immigrants living in Sweden. Hip Int 2024; 34:74-81. [PMID: 37795618 PMCID: PMC10787385 DOI: 10.1177/11207000231182321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Despite the overall success of THA, between 5 and 20% report unsatisfactory results. Several factors may cause this variable outcome. 1 of them might be ethnicity which, because of its potential social impact on living conditions, may influence quality of life too. It should be studied whether patients born and being operated in their home country Bosnia and Herzegovina (BH) had similar results as immigrants being operated in Sweden (IS). METHODS Data of 280 patients were collected prospectively from questionnaires in the BH group. Patients of the IS group were eligible if both of their parents were born outside the Nordic countries, not having Swedish as their native language. Data were gained from the Swedish Arthroplasty Registry (SAR), 449 patients were included. Outcomes were pain VAS, satisfaction VAS, EQ-VAS, and the EQ-5D. Logistic and linear regression models including age, sex, diagnosis, type of fixation, surgical incision, marital status and educational level were analysed to compare those 2 groups. RESULTS There were considerable differences in patient demographics between the 2 groups. Before the operation, patients in the BH group reported more problems with self-care and usual activities, even after adjustment for confounding factors (p < 0.0005). Patients in the IS group reported a higher EQ-VAS and more pain VAS (p < 0.0005), the difference in the EQ-VAS was not significant after adjustment for confounding factors (p = 0.41). After 1 year patients in the BH group reported better scores in all dimensions of the EQ-5D (p ⩽ 0.005) apart from self-care. After adjustment for confounding factors, patients in the BH group were more satisfied too (p < 0.0005). CONCLUSIONS Immigrated patients (IS group) seemed to experience less benefit from THA 1 year after the operation despite more symptoms preoperatively. There were considerable limitations affecting the results. Nevertheless, the data are a point of concern, and it is suggested to take more multidimensional care of immigrant patients.
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Affiliation(s)
- Ferid Krupic
- Department of Anaesthesiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Swedish Joint Arthroplasty Register, Gothenburg, Sweden
| | - Slavko Manojlovic
- School of Medicine, University of Banjaluka, Banja Luka, Bosnia and Herzegovina
| | - Svemir Custovic
- Clinic for Orthopaedics and Traumatology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirsad Fazlic
- Clinic for Orthopaedics and Traumatology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sahmir Sadic
- Clinic for Orthopaedics and Traumatology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Swedish Joint Arthroplasty Register, Gothenburg, Sweden
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Lesand L, Dahlin LB, Rydberg M, Zimmerman M. Effects of socioeconomic status on patient-reported outcome after surgically treated trigger finger: a retrospective national registry-based study. BMJ Open 2023; 13:e077101. [PMID: 38101829 PMCID: PMC11148673 DOI: 10.1136/bmjopen-2023-077101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES To investigate if socioeconomic status impacts patient-reported outcomes after a surgically treated trigger finger (TF). DESIGN AND SETTING Data on patients with TF treated with surgery were collected from the Swedish National Quality Registry of Hand Surgery (HAKIR) 2010-2019 with an evaluation of symptoms and disability before surgery and at 3 and 12 months after surgery, using the short version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire.Data from HAKIR and the Swedish National Diabetes Registry (ndr.nu) were combined with socioeconomic data from Statistics Sweden (scb.sc), analysing the impact of marital status, education level, income, occupation, sickness benefits, days of unemployment, social assistance and migrant status on the outcome by a linear regression model. PARTICIPANTS In total, 5477 patients were operated on for primary TF during the study period, of whom 21% had diabetes, with a response rate of 35% preoperatively, 26% at 3 months and 25% at 12 months. RESULTS At all time points, being born in Sweden (preoperatively B-coefficient: -9.74 (95% CI -13.38 to -6.11), 3 months postoperatively -9.80 (95% CI -13.82 to -5.78) and 12 months postoperatively -8.28 (95% CI -12.51 to -4.05); all p<0.001) and high earnings (preoperatively -7.81 (95% CI -11.50 to -4.12), 3 months postoperatively -9.35 (95% CI -13.30 to -5.40) and 12 months postoperatively -10.25 (95% CI -14.37 to -6.13); all p<0.0001) predicted lower QuickDASH scores (ie, fewer symptoms and disability) in the linear regression models. More sick leave during the surgery year predicted higher QuickDASH scores (preoperatively 5.77 (95% CI 3.28 to 8.25; p<0.001), 3 months postoperatively 4.40 (95% CI 1.59 to 7.22; p<0.001) and 12 months postoperatively 4.38 (95% CI 1.35 to 7.40; p=0.005)). No socioeconomic factors impacted the change in QuickDASH score from preoperative to 12 months postoperatively in the fully adjusted model. CONCLUSION Individuals with low earnings, high sick leave the same year as the surgery and those born outside of Sweden reported more symptoms both before and after surgery, but the relative improvement was not affected by socioeconomic factors.
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Affiliation(s)
- Lovisa Lesand
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mattias Rydberg
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Lund, Sweden
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
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