Murali Sudarsan, Elphingstone Joseph W, Paul Kyle D, Messner Mitchell, Frazier Mason B, Narducci Carl A, Phillips Brandon M, Bass Rachel Z, McGwin Gerald, Brabston Eugene W, Ponce Brent A, Momaya Amit M
University of Alabama at Birmingham, Department of Orthopaedic Surgery Birmingham, Birmingham, AL, USA.
University of Alabama at Birmingham, Department of Radiology Birmingham, Birmingham, AL, USA.
JSES Int. 2022 Jun 27;6(5):815-819. doi: 10.1016/j.jseint.2022.05.014. eCollection 2022 Sep.
Rotator cuff tear (RCT) chronicity is an important factor in considering treatment options and outcomes for surgical repair. Many factors may contribute to delayed treatment, including timely access to care due to insurance status. The purpose of this study was to evaluate the relationship between the magnitude of RCT on presentation and insurance status. We hypothesize that publicly insured patients will have a greater incidence of chronic RCTs and shoulder pathology on initial presentation.
Retrospective chart review of patients undergoing RCT repair at an academic tertiary care institution from 2005 to 2019. Demographic data, including age, race, sex, and insurance carrier, were collected. Insurance carriers were categorized into public (Medicare and Medicaid) or private insurance coverage. Individual magnetic resonance imagings were then reviewed by a board-certified musculoskeletal radiologist for supraspinatus (SS), infraspinatus (IS), subscapularis, and biceps tendon tears, as well as acromioclavicular arthritis. In addition, rotator cuff atrophy was evaluated by the scapular ratio. Univariate analysis of variance and logistic regression analyses were used to compare demographics and rotator cuff pathology between those with Medicaid and Medicare, as well as between publicly and privately insured patients.
Of the 492 patients in this study, 192 had private insurance, and 300 had public insurance (Medicaid: 50 and Medicare: 250). Insurance status was not found to be associated with differences in RCTs between Medicare and Medicaid patients. Those with Medicaid or Medicare (public), presented more frequently with SS or IS atrophy (SS atrophy, = .002; IS atrophy, = .039) than those with private insurance. However, after adjusting for age, no significant differences in rotator cuff tendon tear or atrophy frequencies were found between insurance groups.
Patients with private and public insurance tend to present with similar chronicity and magnitude of RCTs. Insurance status does not appear to influence timely access to surgical care for patients with RCTs at an academic medical center.
肩袖撕裂（RCT）的慢性化是考虑手术修复治疗方案和结果的重要因素。许多因素可能导致治疗延迟，包括因保险状况而无法及时获得治疗。本研究的目的是评估初次就诊时RCT的严重程度与保险状况之间的关系。我们假设，公共保险患者初次就诊时慢性RCT和肩部病变的发生率更高。
对2005年至2019年在一所学术性三级医疗机构接受RCT修复的患者进行回顾性病历审查。收集人口统计学数据，包括年龄、种族、性别和保险公司。保险公司分为公共保险（医疗保险和医疗补助）或私人保险。然后由一名获得董事会认证的肌肉骨骼放射科医生对个体磁共振成像进行审查，以检查冈上肌（SS）、冈下肌（IS）、肩胛下肌和肱二头肌肌腱撕裂，以及肩锁关节炎。此外，通过肩胛比例评估肩袖萎缩情况。采用单因素方差分析和逻辑回归分析比较医疗补助和医疗保险患者之间，以及公共保险和私人保险患者之间的人口统计学和肩袖病变情况。
本研究的492例患者中，192例有私人保险，300例有公共保险（医疗补助：50例，医疗保险：250例）。未发现保险状况与医疗保险和医疗补助患者的RCT差异有关。与私人保险患者相比，有医疗补助或医疗保险（公共保险）的患者更常出现SS或IS萎缩（SS萎缩，P = 0.002；IS萎缩，P = 0.039）。然而，在调整年龄后，保险组之间在肩袖肌腱撕裂或萎缩频率上未发现显著差异。
私人保险和公共保险患者的RCT慢性化程度和严重程度往往相似。在学术医疗中心，保险状况似乎不会影响RCT患者及时获得手术治疗。
