Black Patients Less Likely to be Completely Satisfied with Care After TJA

Thanks to data from the Press Ganey inpatient survey, orthopaedic surgeons generally know how satisfied patients are with their total hip and total knee procedures.

What they might not know is how the results break down by race and socioeconomic status.

At the 2022 Annual Meeting of the American Academy of Orthopaedic Surgeons, researchers from Hospital for Special Surgery presented the results of their deeper dive into Press Ganey data for their institution in an effort to gain more insight into patient satisfaction.

“Patient satisfaction related to the hospital experience following surgery is an important aspect of patient care,” said Susan M. Goodman, MD, a rheumatologist at HSS and the study’s senior investigator.

“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.”

Study Methods and Findings

The study included more than 4600 patients from New York, New Jersey, and Connecticut who had undergone total joint arthroplasty – 2516 total hips and 2113 total knees – at HSS between July 2010 and February 2012.

The researchers analyzed the data from the Press Ganey surveys these patients had completed to establish an overall score, calculated as the mean of the patients’ ratings for 3 questions in the “Overall Assessment” section of the survey. The results were categorized as either “completely satisfied” (score of 100) or “not completely satisfied” (score less than 100).

Their analysis found that Black patients were more likely to respond that they were “not completely satisfied” with the process of care right after surgery compared with white patients in both joint replacement groups.

Despite this, Dr. Goodman said that the researchers saw no difference between Black patients and white patients in terms of satisfaction with their joint replacement outcome. Factors such as pain and function are part of the outcome assessment, which is generally conducted 2 years after surgery.

With respect to socioeconomic status, the HSS researchers considered patients’ primary health insurance coverage. They found that an individual’s primary payer was not associated with satisfaction in either joint replacement group.

Removing Barriers to Timely Care

“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 a 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 noted. “Confidence in the health care system may contribute to the delay in seeking care, and this is something we need to address.”

Dr. Goodman concurred, adding that, “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.”


Bass AR, Lai EY, Ma HD, Gibbons JA, Bradford L, Figge MP, Parks ML, Burke O, Goodman SM. Black Patients Are Less Satisfied with the Process of Care Following Primary Hip and Knee Arthroplasty: A Retrospective Study (Poster P0109). Presented at the American Academy of Orthopaedic Surgeons’ 2022 Annual Meeting, March 22-26, 2022, Chicago, Illinois.

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