ArticleJournal of racial and ethnic health disparities2026
Disparities in Total Knee Arthroplasty Outcomes: A Comparison Between Traditional Medicare Beneficiaries in Puerto Rico and the U.S. Mainland.
Article in Journal of racial and ethnic health disparities, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
introductionLimited 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.
methodsThis 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.
resultsThe 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.
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