Sabesan V J, Lima D J L, Goss L, Gauger M, Whaley J D, Ghisa C, Malone D L
Department of Orthopaedic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
Department of Orthopaedic Surgery, Wayne State University School of Medicine, Troy, MI, USA.
Musculoskelet Surg. 2021 Apr;105(1):43-47. doi: 10.1007/s12306-019-00627-w. Epub 2019 Nov 11.
Low socioeconomic status and Medicaid insurance as a primary payer have been shown to influence resource utilization and risk-adjusted outcomes for total joint arthroplasty. The purpose of this study was to assess the effects of Medicaid primary payer status on outcomes following shoulder arthroplasty (SA).
A retrospective review of shoulder surgery patients was undertaken to identify a matched cohort of 51 patients who underwent SA and were stratified based on insurance type into two cohorts: 28 Medicaid (M) patients and 23 non-Medicaid (NM) patients. Baseline demographics, resource utilization, and outcomes were compared as well as pre-and-postoperative patient-reported outcomes (PRO) and functional scores. PRO scores included the American shoulder and elbow surgeons score (ASES), the Penn shoulder score (PSS), and the subjective shoulder value (SSV).
There were no statistically significant differences in demographics, comorbidities, or preoperative baseline scores between the cohorts, except for age (M: 55.3 years; NM: 67.5 years; p ≤ 0.001) and smoking status (M: 13 patients; NM: 4 patients; p = 0.029). Medicaid patients showed a slightly higher rate of missed follow-ups (M: 1.1 vs. NM: 0.9; p = 0.370). All Medicaid and non-Medicaid patients experienced significant improvement on PRO scores and active forward flexion. Medicaid patients demonstrated equivalent final postoperative scores for ASES (M: 65; NM: 57; p = 0.454), PSS (M: 63; NM: 51; p = 0.242), SSV (M: 70; NM: 69; p = 1.0) and range of motion measurements.
Overall results suggest that Medicaid patients can expect significant improvement after SA and the same level of PRO's compared to non-Medicaid-insured population.
Level III, Retrospective Comparative Design, Treatment Study.
社会经济地位低下以及以医疗补助保险作为主要支付方已被证明会影响全关节置换术的资源利用和风险调整后的治疗结果。本研究的目的是评估医疗补助主要支付方身份对肩关节置换术（SA）后治疗结果的影响。
对肩部手术患者进行回顾性研究，以确定51例接受SA的匹配队列患者，并根据保险类型将其分为两个队列：28例医疗补助（M）患者和23例非医疗补助（NM）患者。比较了基线人口统计学、资源利用和治疗结果，以及术前和术后患者报告的结果（PRO）和功能评分。PRO评分包括美国肩肘外科医生评分（ASES）、宾夕法尼亚肩部评分（PSS）和主观肩部价值（SSV）。
除年龄（M组：55.3岁；NM组：67.5岁；p≤0.001）和吸烟状况（M组：13例患者；NM组：4例患者；p = 0.029）外，两组在人口统计学、合并症或术前基线评分方面无统计学显著差异。医疗补助患者的失访率略高（M组：1.1次；NM组：0.9次；p = 0.370）。所有医疗补助和非医疗补助患者的PRO评分和主动前屈均有显著改善。医疗补助患者术后ASES（M组：65分；NM组：57分；p = 0.454）、PSS（M组：63分；NM组：51分；p = 0.242）、SSV（M组：70分；NM组：69分；p = 1.0）的最终评分以及活动范围测量结果相当。
总体结果表明，与非医疗补助保险人群相比，医疗补助患者在SA后可预期有显著改善，且PRO水平相同。
III级，回顾性比较设计，治疗研究。
