From the Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J.A. Singh, MBBS, MPH, Birmingham VA Medical Center, and Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham; J.D. Cleveland, MS, Department of Medicine at the School of Medicine, University of Alabama at Birmingham.
J Rheumatol. 2020 Apr;47(4):589-596. doi: 10.3899/jrheum.190287. Epub 2019 Jun 1.
To assess the independent association of insurance and patient income with total shoulder arthroplasty (TSA) outcomes.
We used the 1998-2014 US National Inpatient Sample. We used multivariable-adjusted logistic regression to examine whether insurance type and the patient's median household income (based on postal code) were independently associated with healthcare use (discharge destination, hospital stay duration, total hospital charges) and in-hospital complications post-TSA based on the diagnostic codes (fracture, infection, transfusion, or revision surgery). We calculated the OR and 95% CI.
Among the 349,046 projected TSA hospitalizations, the mean age was 68.6 years, 54% were female, and 73% white. Compared to private insurance, Medicaid and Medicare (government insurance) users were associated with significantly higher adjusted OR (95% CI) of (1) discharge to a rehabilitation facility, 2.16 (1.72-2.70) and 2.27 (2.04-2.52); (2) hospital stay > 2 days, 1.65 (1.45-1.87) and 1.60 (1.52-1.69); and (3) transfusion, 1.35 (1.05-1.75) and 1.39 (1.24-1.56), respectively. Medicaid was associated with a higher risk of fracture [1.74 (1.07-2.84)] and Medicare user with a higher risk of infection [2.63 (1.24-5.57)]; neither were associated with revision. Compared to the highest income quartile, the lowest income quartile was significantly associated with (OR, 95% CI): (1) discharge to a rehabilitation facility (0.89, 0.83-0.96); (2) hospital stay > 2 days (0.84, 0.80-0.89); (3) hospital charges above the median (1.19, 1.14-1.25); (4) transfusion (0.73, 0.66-0.81); and (5) revision (0.49, 0.30-0.80), but not infection or fracture.
This information can help to risk-stratify patients post-TSA. Future assessments of modifiable mediators of these complications are needed.
评估保险和患者收入与全肩关节置换术（TSA）结果的独立相关性。
我们使用了 1998 年至 2014 年美国国家住院患者样本。我们使用多变量调整逻辑回归来检查保险类型和患者的中位数家庭收入（基于邮政编码）是否与医疗保健使用（出院目的地、住院时间长短、总住院费用）以及基于诊断代码（骨折、感染、输血或翻修手术）的 TSA 术后院内并发症独立相关。我们计算了比值比（OR）和 95%置信区间（CI）。
在预计的 349046 例 TSA 住院患者中，平均年龄为 68.6 岁，54%为女性，73%为白人。与私人保险相比，医疗补助和医疗保险（政府保险）患者的调整后 OR（95%CI）显著更高，（1）转至康复机构的可能性为 2.16（1.72-2.70）和 2.27（2.04-2.52）；（2）住院时间>2 天的可能性为 1.65（1.45-1.87）和 1.60（1.52-1.69）；（3）输血的可能性为 1.35（1.05-1.75）和 1.39（1.24-1.56）。医疗补助与骨折风险增加相关[1.74（1.07-2.84）]，而医疗保险与感染风险增加相关[2.63（1.24-5.57）]；两者均与翻修无关。与收入最高的四分位数相比，收入最低的四分位数与以下方面显著相关：（1）转至康复机构（0.89，0.83-0.96）；（2）住院时间>2 天（0.84，0.80-0.89）；（3）住院费用高于中位数（1.19，1.14-1.25）；（4）输血（0.73，0.66-0.81）；（5）翻修（0.49，0.30-0.80），但与感染或骨折无关。
这些信息可以帮助 TSA 术后患者进行风险分层。需要进一步评估这些并发症的可调节介质。
