Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2023 Mar;32(3):597-603. doi: 10.1016/j.jse.2022.09.003. Epub 2022 Oct 5.
Despite strong evidence supporting the efficacy of rotator cuff repair (RCR), previous literature has demonstrated that socioeconomic disparities exist among patients who undergo surgery. There is a paucity of literature examining whether payor type, including Medicare, Medicaid, and commercial insurance types, impacts early medical complications and rates of reoperation after RCR.
Patients with Medicare, Medicaid, or commercial payor-type insurance who underwent primary open or arthroscopic RCR between 2010 and 2019 were identified using a large national database. Ninety-day incidence of medical complications, emergency department (ED) visit, and hospital readmission, as well as 1-year incidence of revision repair, revision to arthroplasty, and cost of care were evaluated. Propensity-score matching was used to control for patient demographic factors and comorbidities as covariates.
A total of 113,257 Medicare, 23,074 Medicaid, and 414,447 commercially insured patients were included for analysis. Medicaid insurance was associated with an increased 90-day risk of various medical complications, ED visit (odds ratio [OR]: 2.87; P < .001), and 1-year revision RCR (OR: 1.60; P < .001) compared with Medicare insurance. Medicaid insurance was also associated with an increased risk of various medical complications, ED visit (OR: 2.98; P < .001), and hospital readmission (OR: 1.56; P = .002), as well as 1-year risk of revision RCR (OR: 1.60; P < .001) and conversion to arthroplasty (OR: 1.4358; P < .001) compared with commercially insured patients. Medicaid insurance was associated with a decreased risk of conversion to arthroplasty compared with Medicare patients (OR: 0.6887; P < .001). Medicaid insurance was associated with higher 1-year cost of care compared with patients with both Medicare (P < .001) and commercial insurance (P < .001).
Medicaid insurance is associated with increased rates of medical complications, health care utilization, and reoperation after rotator cuff surgery, despite controlling for covariates. Medicaid insurance is also associated with a higher 1-year cost of care. Understanding the complex relationship between sociodemographic factors, such as insurance status, medical comorbidities, and outcomes, is necessary to ensure optimal health care access for all patients and to allow for appropriate risk stratification.
尽管有强有力的证据支持肩袖修复术（RCR）的疗效，但先前的文献表明，接受手术的患者存在社会经济差异。关于支付类型（包括医疗保险、医疗补助和商业保险类型）是否会影响 RCR 后的早期医疗并发症和再次手术率，文献研究较少。
使用大型国家数据库，确定了 2010 年至 2019 年间接受初次开放式或关节镜下 RCR 的 Medicare、医疗补助或商业支付类型保险的患者。评估 90 天内医疗并发症、急诊就诊和住院再入院的发生率，以及 1 年时修复翻修、翻修为关节置换术和治疗费用的发生率。使用倾向评分匹配来控制患者人口统计学因素和合并症作为协变量。
共纳入 113257 名 Medicare、23074 名医疗补助和 414447 名商业保险患者进行分析。与医疗保险相比，医疗补助保险与各种医疗并发症、急诊就诊（优势比[OR]：2.87；P<0.001）和 1 年时的修复 RCR（OR：1.60；P<0.001）的 90 天风险增加相关。医疗补助保险还与各种医疗并发症、急诊就诊（OR：2.98；P<0.001）和住院再入院（OR：1.56；P=0.002）以及 1 年时修复 RCR（OR：1.60；P<0.001）和转为关节置换术（OR：1.4358；P<0.001）的风险增加相关，与商业保险患者相比。与医疗保险相比，医疗补助保险与转为关节置换术的风险降低（OR：0.6887；P<0.001）相关。与 Medicare 患者（P<0.001）和商业保险患者（P<0.001）相比，医疗补助保险与 1 年的治疗费用较高相关。
尽管控制了协变量，但医疗保险与肩袖手术后的医疗并发症、医疗保健利用和再次手术率增加有关。医疗保险也与较高的 1 年治疗费用相关。了解社会人口因素（如保险状况、医疗合并症和结果）之间的复杂关系，对于确保所有患者获得最佳的医疗保健机会并进行适当的风险分层是必要的。
