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Latest Prevention & Wellness News<\/h3>\n
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By Amy Norton<\/b>
HealthDay Reporter<\/i><\/p>\n
FRIDAY, Sept. 18, 2020 (HealthDay News)<\/p>\n
The COVID-19<\/a> pandemic has shown a spotlight on disparities in the U.S. health care system. But the issues are longstanding, and — as one large study illustrates — extend into a common elective surgery.<\/p>\n Researchers found that when hip replacement<\/a> surgery is done at a “safety net” hospital designed to serve the poor and uninsured, patients’ risks are higher. Of more than 500,000 Americans who had the surgery, those at safety net hospitals were 11% more likely to have postoperative complications, like infections or heart<\/a> problems.<\/p>\n And while few patients died, patients at safety net hospitals had more than a third greater risk.<\/p>\n In the United States, safety net hospitals are obligated — by mandate or mission — to treat people regardless of their ability to pay. So, they typically have a large share of patients who are low-income, minority and either uninsured or on Medicaid.<\/p>\n A number of studies have found that Black, Latino and Medicaid patients have more complications after joint replacement surgery, versus white and privately insured patients.<\/p>\n But do hospitals, themselves, play a role in those disparities? The answer is “a definite yes,” said Dr. Kevin Bozic, chair of surgery and perioperative care at the University of Texas at Austin Dell Medical School.<\/p>\n Bozic, who was not involved in the research, said it adds to evidence that differences in hospital care are part of the problem.<\/p>\n “Safety net hospitals do the best they can with the resources they have,” he said.<\/p>\n But because they are operating on slim margins, Bozic said, they cannot make investments that more profitable hospitals can. That includes the extra help more vulnerable patients often need — including social workers, transportation and nutritional support.<\/p>\n The irony is that hospitals with the most patients in need are the least likely to have social support resources, according to Bozic.<\/p>\n The findings, published in the journal Regional Anesthesia & Pain<\/a> Medicine<\/i>, are based on discharge records from hospitals in five U.S. states. The patients underwent hip replacement<\/a> between 2007 and 2014.<\/p>\n It’s a period well before the COVID-19<\/a> pandemic, which has laid bare the disparities in U.S. health care.<\/p>\n Now, with increased attention on those longstanding issues, the momentum may be in place to address them, said Dr. Robert White.<\/p>\n White, who led the study, is an anesthesiologist at New York Presbyterian Hospital-Weill Cornell Medicine in New York City.<\/p>\n He said his research cannot pinpoint the reasons safety net hospitals might fall short. But like Bozic, he pointed to lack of resources as a likely factor.<\/p>\n Overall, White’s team found, patients at safety net hospitals had an in-hospital death rate of 0.2%, versus 0.1% at hospitals with relatively few Medicaid and uninsured patients.<\/p>\n The researchers weighed other factors that could explain the difference — including patients’ medical conditions — and found that safety net hospitals were still an independent factor: Patients there were 30% to 38% more likely to die, relative to those at other hospitals.<\/p>\n In addition, their rate of infection was higher (1.6% versus 1.4%), as was their rate of heart<\/a>-related complications (1.5%, versus 1.4%).<\/p>\n Dr. Charles Nelson is chief of the joint replacement service at Penn Medicine in Philadelphia. Reviewing the study, he said that safety net hospitals face a big challenge: They generally have “more complex” patients who may be in poorer health, have less social support and may more often need hip replacement due to a fracture<\/a>, rather than to treat painful arthritis<\/a>.<\/p>\n Adding to the financial strain, Nelson pointed out, safety net hospitals are more affected by Medicare rules that penalize hospitals for having high readmission rates.<\/p>\n Racial disparities in joint replacement outcomes are “multi-factorial,” Nelson said, and it’s difficult to separate the reasons from each other.<\/p>\n Patients on Medicaid may be limited in how much hospital-shopping they can do before elective hip surgery. But Nelson recommended asking some basic questions before deciding on a hospital: How many procedures does the hospital and surgeon do each year? And what is the postoperative complication rate?<\/p>\n![\"MedicalNews\"](\"https:\/\/images.medicinenet.com\/images\/HealthDay\/healthday.png\")
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