Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, USA.
Department of Anesthesiology, Weill Cornell Medicine Center for Perioperative Outcomes, New York, USA.
Reg Anesth Pain Med. 2019 Feb;44(2):182-190. doi: 10.1136/rapm-2018-000020.
Inpatient shoulder arthroplasty is widely performed around the USA at an increasing rate. Medicaid insurance has been identified as a risk factor for inferior surgical outcomes. We sought to identify the impact of being Medicaid-insured on in-hospital mortality, readmission, complications, and length of stay (LOS) in patients who underwent inpatient shoulder arthroplasty.
We analyzed 89 460 patient discharge records for inpatient total, partial, and reverse shoulder arthroplasties using data from the Healthcare Cost and Utilization Project's State Inpatient Databases for California, Florida, New York, Maryland, and Kentucky from 2007 through 2014. We compared patient demographics, present-on-admission comorbidities, and hospital characteristics by insurance payer. We estimated multilevel mixed-effect multivariate logistic regression models and generalized linear models to assess insurance's effect on in-hospital mortality, readmission, infectious complications, cardiac complications, and LOS; models controlled for patient and hospital characteristics.
Medicaid-insured patients had greater odds than patients with private insurance, other insurance, and Medicare of inpatient mortality (OR: 4.61, 95% CI 2.18 to 9.73, p<0.001) and 30-day and 90-day readmissions (OR: 1.94, 95% CI 1.57 to 2.38, p<0.001; OR: 1.65, 95% CI 1.42 to 2.38, p<0.001, respectively). Compared with private insurance, other insurance, and Medicare patients, Medicaid patients had increased likelihood of developing infectious complications and were expected to have longer LOS.
Our study supports our hypothesis that among inpatient shoulder arthroplasty patients, those with Medicaid insurance have worse outcomes than patients with private insurance, other insurance, and Medicare. These results are relatively consistent with previous findings in the literature.
在美国，住院肩部置换手术的应用日益广泛，且数量不断增加。医疗补助保险被认为是手术结果较差的一个风险因素。我们旨在确定接受住院肩部置换手术的患者中，医疗保险的覆盖情况对住院死亡率、再入院率、并发症和住院时间（LOS）的影响。
我们使用 2007 年至 2014 年期间来自加利福尼亚州、佛罗里达州、纽约州、马里兰州和肯塔基州的医疗保健成本和利用项目州住院数据库的数据，分析了 89460 例住院全肩关节置换术、部分肩关节置换术和反肩关节置换术患者的出院记录。我们比较了不同保险类型患者的人口统计学特征、入院时合并症和医院特征。我们使用多水平混合效应多元逻辑回归模型和广义线性模型来评估保险对住院死亡率、再入院率、感染性并发症、心脏并发症和 LOS 的影响；模型控制了患者和医院的特征。
与私人保险、其他保险和医疗保险患者相比，医疗补助保险患者的住院死亡率（OR：4.61，95%置信区间 2.18 至 9.73，p<0.001）和 30 天和 90 天再入院率（OR：1.94，95%置信区间 1.57 至 2.38，p<0.001；OR：1.65，95%置信区间 1.42 至 2.38，p<0.001）更高。与私人保险、其他保险和医疗保险患者相比，医疗补助保险患者发生感染性并发症的可能性更高，且预计 LOS 更长。
我们的研究支持我们的假设，即接受住院肩部置换手术的患者中，医疗保险患者的结局比私人保险、其他保险和医疗保险患者差。这些结果与文献中的先前发现基本一致。
