Background/Purpose: To compare patient characteristics, utilization rates and outcomes after total elbow arthroplasty (TEA) by sex.

Methods: We used the nationwide Inpatient Sample from 1998-2011 to study sex-related time-trends in patient characteristics, comorbidity and outcomes after TEA.  We used chi-square test, analysis of variance and the Cohran-Armitage test to assess differences in utilization rates and characteristics over time by sex and logistic regression to compare mortality, discharge disposition and the length of hospital stay.

Results: Overall TEA utilization increased significantly from 0.45 in 1998 to 0.96 per 100,000 in 2011 (p<0.0001).  The utilization rates were significantly higher in females compared to males throughout the study period: 0.62 vs. 0.29 in 1998 (p<0.0001) and 1.31 vs. 0.70 in 2011 (p<0.0001).  Compared to males, females undergoing TEA were more likely to be White (79.7% vs. 71.4%; p<0.0001), have rheumatoid arthritis (16.7% vs. 8.1%; p<0.0001) and have Deyo-Charlson index of 2 or more (11.3% vs. 5.9%; p<0.0001) and were older (63.5 vs. 51.4 years; p<0.0001).  Compared to males undergoing TEA, females had significantly lower mortality, 0.1% vs. 0.4% (p=0.03); lower proportion were discharged to home, 81.9% vs. 89.6% (p<0.0001) and fewer has index hospital stay above the median, 30.0% vs. 33.0% (p=0.01); most differences were significant after multivariable adjustment.

Conclusion: TEA utilization in the U.S. more than doubled in the last 14 years, with rates higher in females than males.  Females had better outcomes after TEA than men.  Preoperative risk communication should be sex-specific based on these data.