Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
JBJS Rev. 2020 Apr;8(4):e0085. doi: 10.2106/JBJS.RVW.19.00085.
Access to elective total knee arthroplasty is important in the treatment of end-stage arthritis, and numerous initiatives, including Medicaid expansion, have sought to improve patients' ability to undergo this procedure. However, despite this, the role of Medicaid insurance in patient outcomes remains unclear. The purpose of this study was to perform a systematic review of the literature to explore the relationship between preoperative Medicaid insurance status and outcomes following primary total knee arthroplasty.
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies examining outcomes in patients who had Medicaid and were undergoing total knee arthroplasty. Studies including complex revision operations or less common indications for total knee arthroplasty were excluded. Data on insurance status, postoperative complications, length of stay, readmissions, and subsequent revision surgical procedures were collected for each article.
A total of 13 studies showing 6.18 million patients undergoing total knee arthroplasty were included in the qualitative synthesis. Seven analyses described an important association between Medicaid coverage and short-term readmissions, and 2 analyses showed a relationship between Medicaid and prolonged length of stay. However, the included studies did not describe a significant association between Medicaid and postoperative mortality or revision rates.
Patients with Medicaid undergoing total knee arthroplasty may be more likely to experience an increased length of stay and to be readmitted postoperatively. The unique factors associated with these patients may help to inform customized perioperative surveillance and optimization to improve outcomes in this group.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
获得择期全膝关节置换术对于治疗终末期关节炎非常重要，许多举措，包括扩大医疗补助计划，都旨在提高患者接受该手术的能力。然而，尽管如此，医疗补助保险在患者结局中的作用仍不清楚。本研究的目的是进行系统评价，以探讨术前医疗补助保险状况与初次全膝关节置换术后结局之间的关系。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价，以确定研究患者的保险状况与全膝关节置换术后结局的关系，这些患者接受医疗补助计划，并接受全膝关节置换术。排除了包括复杂翻修手术或全膝关节置换术少见适应证的研究。对每个文章中有关保险状况、术后并发症、住院时间、再入院和随后的翻修手术的数据进行了收集。
纳入了 13 项研究，这些研究共纳入了 618 万名接受全膝关节置换术的患者，进行了定性综合分析。有 7 项分析描述了医疗补助覆盖与短期再入院之间的重要关联，2 项分析显示了医疗补助与住院时间延长之间的关系。然而，纳入的研究没有描述医疗补助与术后死亡率或翻修率之间的显著关联。
接受全膝关节置换术的 Medicaid 患者可能更有可能经历住院时间延长和术后再入院。与这些患者相关的独特因素可能有助于提供定制的围手术期监测和优化，以改善该组患者的结局。
预后 IV 级。请参阅作者指南，以获得证据水平的完整描述。
