---
title: 'Predictors of Disparities in Patient-Reported Outcomes before and after Arthroscopic Meniscectomy'
type: 'lecture'
url: 'https://doc.social/lectures/predictors-of-disparities-in-patient-reported-outcomes-before-and-after-arthroscopic-menis'
published: '2022-05-28'
author: 'Christopher Bloise'
transcript: 'yes'
---

# Predictors of Disparities in Patient-Reported Outcomes before and after Arthroscopic Meniscectomy

## Summary

Presentation of published original article in The Journal of Knee Surgery

Bloise C, Fong B, Jeffers K, Bronstone A, Leonardi C, Veale T, Poche J, Dasa V. Predictors of Disparities in Patient-Reported Outcomes before and after Arthroscopic Meniscectomy. J Knee Surg. 2022 Feb 25. doi: 10.1055/s-0042-1743229. PMID: 35213921.

## Transcript

889 words · 6 min · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source.

[0:01] Hi, I'm Christopher Bloys. I'm a fourth-year medical student at LSU in New Orleans, and I'm presenting my project Predictors of Disparities in Patient-reported Outcomes before and after Arthroscopic meniscectomy.
[0:14] Patients with symptomatic Knee Osteoarthritis are frequently found to have meniscal tears, which are commonly treated surgically with Arthroscopic meniscectomy. Although this practice is now considered controversial due to recent literature showing that conservative treatments are equally efficacious in improving outcomes, it is still common with over 500,000 surgeries being performed each year.
[0:34] Few studies have examined patient factors associated with Patient-reported outcomes before and after Arthroscopic meniscectomy, found that sex, age, BMI, KL grade influence outcomes.
[0:45] There have been no studies that have examined the effect of race or insurance status on pros before or after mastectomy, although these types of disparities have been consistently reported in TKA outcomes.
[0:57] This lack of Research, the purpose of our study was to evaluate the relationship between patient demographic and clinical characteristics, particularly race and insurance type, and Patient-reported outcomes before and 3 months after Arthroscopic meniscectomy, which is the time point that has been shown when patients gain the most benefit from Surgery.
[1:18] Our study was a Retrospective chart review of patients aged 18 years or older who underwent Primary single Knee, full or partial Arthroscopic meniscectomy. Indications for Surgery included an MRI finding of meniscal tear and failed nonopperational management.
[1:34] We excluded patients with a KO grade of 4 because TKA is more appropriate in these patients, as well as patients who had previous or bilateral Knee Surgery and concomitant procedures.
[1:45] And the recommended Rehabilitation protocol was 2 weeks of supervised PT starting the day after Surgery along with home exercises.
[1:56] For the variables we collected, they included demographic and clinical characteristics such as age, sex, race, and insurance status. The Primary outcomes we looked at were acute symptoms, Pain, and ADL subscales, both before and 90 days after Surgery.
[2:12] As part of analysis, we define successful treatment as meeting or exceeding the 10 point minimal clinically important difference on K 3 months post-op.
[2:25] In our study, we had 251 patients that were included in our analysis of predictors of pre-op who scores, and 120 patients for analysis of predictors of 90 day post-op scores. Our sample was 67% female, 50% white race, 40% black races, and had a roughly equal distribution between private Medicare and Medicaid insurance types.
[2:48] Pre-op analysis, we found that black race and Medicaid insurance were associated with worse pre-op scores in all subscals compared to white race and private and Medicare insurance.
[2:59] Female sex and older age were also found to be an issue with worst pre-op scores.
[3:04] But only in a single subscale.
[3:10] For 90-day post-op analysis, Medicaid insurance was also found to be associated with significantly worse ADL scores.
[3:17] More severe preoperative Knee problems were found to be associated with worse postoperative outcomes, and right Knee scored worse in Pain and ADL subscales compared to left knees.
[3:30] For MCID analysis, overall, roughly 70% of patients achieved MCID in all COS subskills at 90 days post-op. Klegrade was found to be a strong predictor of mean COUS MCID.
[3:42] With patients with KO grade of 3 being significantly less likely to achieve MCID in all subscals compared to patients with a KO grade of 1, the odds ratio being less than 0.2 in all subscales.
[3:54] Patients with Medicaid insurance were also less likely to achieve NCID in the symptoms and ADL subskills compared to private and Medicare patients, the odds ratio being 0.11 or less.
[4:06] And then better pre-op scores, right knees, and greater comorbidities were also found to be predictors of a decreased likelihood of achieving NCID.
[4:17] So in our study, female sex, black race, and Medicaid insurance were associated with worse preoperative pre scores, which is consistent with Other studies on meniscectomies and TKAs.
[4:28] 3 months after Arthroscopic meniscectomy, patients with moderate radiographic Osteoarthritis, Medicaid insurance, and better preoperative CUS scores were less likely to achieve NCID on at least 2 of the 3 CUS subscales.
[4:42] Greater radiographic Osteoarthritis has been shown to result in less benefit from meniscectomies and several Other studies.
[4:50] Our study further suggests that these patients should be carefully evaluated before undergoing Surgery as their symptoms could be due to an underlying
[4:58] Degenerative process rather than a meniscal tear.
[5:01] The race and insurance-based disparities found in our study could be due to poor access or utilization of healthcare.
[5:10] It's been shown that black patients are less likely to undergo Surgery within 6 months of diagnosis of meniscal tear compared to white patients, and Medicaid patients experience longer wait times for orthopedic appointments and are more likely to be denied an appointment due to lack of referral.
[5:26] So had several limitations. The poor followup rate at 90 days post-op makes our study prone to selection bias, and a relatively small sample size may have reduced the power to detect significant effects.
[5:39] Also, we were unable to collect non-surgical treatment utilization such as joint injections, Pain meds, and Physical therapy.
[5:47] Differential use in response to these treatments, as well as post-op Rehabilitation may contributed to the insurance-based disparities in our study.
[5:57] Australia adds to the growing body of literature on health inequalities in Orthopedics, and surgeons should be aware of these in order to be able to develop and implement strategies to minimize them and provide the best care to their patients.
[6:09] Thanks.