Study finds lesser satisfaction with care after knee or hip replacement among Black patients

A study presented today at the American Academy of Orthopaedic Surgeons (AAOS) 2022 Annual Meeting found that Black patients were less likely than white patients to be completely satisfied with the process of care following knee or hip replacement. Socioeconomic status was not found to play a role in patient satisfaction.

Patient satisfaction related to the hospital experience following surgery is an important aspect of patient care. The Press Ganey inpatient survey is commonly administered to patients to assess their satisfaction with the process of care. Our aim was to determine whether overall patient assessment scores differed by race or socioeconomic status."

Susan M. Goodman, MD, rheumatologist at Hospital for Special Surgery (HSS) and senior investigator

Dr. Goodman and a team of researchers reviewed the Press Ganey survey responses of more than 4,600 patients who had surgery at HSS from July 2010 to February 2012. Individuals having a primary knee or hip replacement who resided in New York, New Jersey or Connecticut were included in the study.

Researchers analyzed the data to establish an overall score, calculated as the mean of a patient's ratings for three questions in the "Overall Assessment" section of the Press Ganey survey. The results were categorized as either "completely satisfied" (score of 100) or "not completely satisfied" (score <100).

The analysis, which included 2,516 individuals who underwent hip replacement and 2,113 who had a knee replacement, found that Black patients were more likely to indicate they were "not completely satisfied" compared to white patients in both joint replacement groups.

Dr. Goodman said that although Black patients indicated they were less satisfied with the process of care right after surgery, there was no difference in satisfaction with their joint replacement outcome. Factors such as pain and function are part of the outcome assessment, which is generally conducted two years after surgery.

With respect to socioeconomic status, researchers considered the patient's primary health insurance coverage. The study found that the individual's primary payor was not associated with satisfaction in either joint replacement group.

"The study is important because we know that Black patients generally wait longer to seek treatment, presenting with worse pain and function prior to surgery, and we are trying to sort out the barriers to seeking timely care," said Mark P. Figgie, MD, chief emeritus of the Surgical Arthritis Service at HSS and co-author of the study.

"Patient outcome measures indicate that although Black patients achieve significant improvement after surgery, it does not reach the same level as those who seek timely treatment," he added. "Confidence in the health care system may contribute to the delay in seeking care, and this is something we need to address."

Dr. Goodman added, "More research is needed to investigate other factors, such as perceived staff courtesy and baseline pain and function, to understand why disparities exist so we can achieve a high level of patient satisfaction for everyone."

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