Sabesan V, Whaley J, Petersen-Fitts G, Sherwood A, Sweet M, Lima D J L, Malone D
Orthopaedics Department, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, MI, USA.
Musculoskelet Surg. 2018 Dec;102(3):267-272. doi: 10.1007/s12306-017-0528-2. Epub 2017 Nov 28.
The influence of socioeconomic status and insurance type has not been studied extensively for RCR, particularly not in the high risk massive RCT population. The purpose of this study is to identify relationships between Medicaid payer status and patient outcomes following massive RCR.
A retrospective review of shoulder surgery database identified 29 patients undergoing massive rotator cuff repair. Patients were stratified based on insurance type into two cohorts, Medicaid (14 patients) and non-Medicaid (15 patients). Missed routine follow-up appointments and comorbidities were recorded and compared between groups. Group comparisons were made for pre- and postoperative patient-reported and functional outcomes. Outcome scores included American Shoulder and Elbow Shoulder Score (ASES), the Penn Shoulder Score, and the Subjective Shoulder Value (SSV). A p value of < 0.05 was considered significant for all statistical analyses.
Medicaid patients were on average 7.1 years younger than non-Medicaid patients (49.8 vs. 56.9 years, respectively), and remaining demographics were comparable between groups. Preoperative patient-reported outcomes were only significantly different for ASES and ASES pain (p = 0.010, 0.037). There was excellent average improvement for Medicaid patients but no significant differences compared to non-Medicaid patients for ASES (p = 0.630), PENN scores (p = 0.395), and SSV (p = 0.198). Medicaid patients also had a higher number of missed and canceled appointments (28%) compared to non-Medicaid patients (18%).
Medicaid coverage will expand to millions of uninsured Americans under current healthcare reform. Medicaid patients with massive RCT appear to significantly improve with surgical treatment.
社会经济地位和保险类型对肩袖修复（RCR）的影响尚未得到广泛研究，尤其是在高风险大规模随机对照试验（RCT）人群中。本研究的目的是确定在大规模RCR后医疗补助支付者状态与患者预后之间的关系。
对肩部手术数据库进行回顾性分析，确定29例行大规模肩袖修复术的患者。根据保险类型将患者分为两组，医疗补助组（14例患者）和非医疗补助组（15例患者）。记录并比较两组患者错过的常规随访预约和合并症情况。对术前和术后患者报告的结局及功能结局进行组间比较。结局评分包括美国肩肘外科协会（ASES）评分、宾夕法尼亚肩部评分和主观肩部价值（SSV）评分。所有统计分析中，p值<0.05被认为具有统计学意义。
医疗补助患者的平均年龄比非医疗补助患者小7.1岁（分别为49.8岁和56.9岁），两组其余人口统计学特征相当。术前患者报告的结局仅在ASES评分和ASES疼痛方面存在显著差异（p = 0.010，0.037）。医疗补助患者的平均改善情况良好，但与非医疗补助患者相比，在ASES评分（p = 0.630）、宾夕法尼亚评分（p = 0.395）和SSV评分（p = 0.198）方面无显著差异。与非医疗补助患者（18%）相比，医疗补助患者错过和取消预约的次数也更多（28%）。
根据当前医疗改革，医疗补助覆盖范围将扩大到数百万未参保的美国人。接受大规模RCT的医疗补助患者经手术治疗后似乎有显著改善。
