Gender, Racial, and Ethnic Reporting in Trials of Regional Anesthesia for Total Joint Arthroplasty: A Systematic Review
Uchenna O. Umeh MD FASA FASRA1,2, Oluwaseun Akinkuolie BS3, Juliet E. Rowe MPH1, Pa Thor PhD1, Cassandra Cu MS4, Laura Le BS5, Emma Davidoff6, Jessica Udeogu6, Lisa V. Doan MD7
1Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 2Department of Anesthesiology, Weill Cornell Medicine, 3CUNY School of Medicine, 4Tufts University School of Medicine, 5University of Pittsburgh School of Medicine, 6City College of the City University of New York, 7Department of Anesthesiology, Perioperative Care and Pain Medicine. New York University Grossman School of Medicine
Introduction
Background/Rationale:
•Regional anesthesia provides significant perioperative benefits
•Inadequate demographic representation and reporting in clinical trials may limit the ability to evaluate findings and perpetuate inequities
Objective: To assess the reporting of race, ethnicity, and gender in randomized controlled trials (RCTs) of regional anesthesia for total joint arthroplasty (TJA), one of the most common elective surgeries, conducted in the US
Methods
•This review is exempt from IRB review requirements due to the lack of patient identifying information
•29 published RCTs of regional anesthesia for TJA were identified from the Aggregate Analysis of ClinicalTrials.gov (AACT) from Jan 2015 - Aug 2025
•Data on trial and patient characteristics were extracted and compared between published articles and CT.gov by two independent reviewers
•Primary outcome: reporting of participant gender, race, and ethnicity in publications and registry entries
•Secondary outcomes: demographic distributions across racial and ethnic groups and associations between reporting and study characteristics
•Analyses performed in SAS
Results
•Five studies were excluded following title/ abstract screening and failing to meet other inclusion criteria (Figure 1)
•29 RCTs were included in the final analysis, representing 2,914 participants
•Published journal articles: 28 studies (96.55%) reported gender, 14 (48.28%) reported race, and 5 (17.24%) reported ethnicity in the published journal articles
•CT.gov: 22 (75.86%) reported gender, 12 (41.38%) reported race, and 7 (24.12%) reported ethnicity
•Trial characteristics were not significantly associated with reporting of race, ethnicity, or gender (Table 1)
•Characteristics: funding source, publication year, single vs. multicenter design, geographic region, and number of participants
Discussion
•In US-based regional anesthesia RCTs for TJA, gender is consistently reported, while race and ethnicity are not
•Predominantly white enrollment
•Reporting practices did not differ by trial characteristics, suggesting a field-wide issue
•Inconsistencies in demographic reporting on CT.gov
•Journals should require standardized reporting and investigators should strive to recruit diverse participants while acknowledging the site-specific constraints of recruitment diversity.
