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保险状态与腕管松解术后并发症的关联。

The Association of Insurance Status and Complications After Carpal Tunnel Release.

机构信息

Indiana University School of Medicine, Indianapolis, USA.

出版信息

Hand (N Y). 2023 Mar;18(2):192-197. doi: 10.1177/1558944721990818. Epub 2021 Feb 25.

Abstract

BACKGROUND

Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR.

METHODS

We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included.

RESULTS

Of the 26 151 patients who met inclusion criteria, 2662 (10.2%) had Medicare, 7027 (26.9%) had Medicaid, and 16 462 (62.9%) had commercial insurance. Compared with Medicare, Medicaid status ( < .001) and commercial insurance status ( < .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications.

CONCLUSIONS

The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.

摘要

背景

腕管松解术(CTR)是手外科最常进行的手术之一。手术并发症是罕见但严重的患者不满原因。本研究旨在确定保险状况是否与 CTR 后的并发症独立相关。

方法

我们使用印第安纳州患者护理网络(一个全州范围的健康信息交换),回顾性地确定了 2008 年至 2018 年间接受 CTR 的所有患者,并建立了一个包含患者人口统计学和合并症的数据库。对患者进行了 90 天的随访,以确定是否发生术后并发症。为了尽量减少失访,仅纳入术后 1 年有就诊记录的患者。

结果

在符合纳入标准的 26151 名患者中,有 2662 名(10.2%)有医疗保险,7027 名(26.9%)有医疗补助,16462 名(62.9%)有商业保险。与医疗保险相比,医疗补助状况(<.001)和商业保险状况(<.001)与术后 CTR 并发症独立相关。总体并发症发生率为 2.23%,感染、伤口破裂和复杂性区域疼痛综合征是最常见的并发症。年龄较小、饮酒、糖尿病、高血压和抑郁症也与并发症独立相关。

结论

CTR 后的并发症发生率较低。然而,应在术前评估保险状况、患者人口统计学和合并症,以便对患者进行适当的风险分层。此外,外科医生可以使用这些数据来采取预防措施,如努力管理当前的合并症和生活方式选择,并优化保险覆盖范围。

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