Department of Orthopaedic Surgery, Louisiana State University, New Orleans, Louisiana.
Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California.
J Bone Joint Surg Am. 2023 Jul 5;105(13):979-989. doi: 10.2106/JBJS.22.01336. Epub 2023 May 16.
Medicaid insurance coverage among patients undergoing total hip arthroplasty (THA) or those undergoing total knee arthroplasty (TKA) has been associated with worse postoperative outcomes compared with patients without Medicaid. Surgeons and hospitals with lower annual total joint arthroplasty (TJA) volume have also been associated with worse outcomes. This study sought to characterize the associations between Medicaid insurance status, surgeon case volume, and hospital case volume and to assess the rates of postoperative complications compared with other payer types.
The Premier Healthcare Database was queried for all adult patients who underwent primary TJA from 2016 to 2019. Patients were divided on the basis of their insurance status: Medicaid compared with non-Medicaid. The distribution of annual hospital and surgeon case volume was assessed for each cohort. Multivariable analyses were performed accounting for patient demographic characteristics, comorbidities, surgeon volume, and hospital volume to assess the 90-day risk of postoperative complications by insurance status.
Overall, 986,230 patients who underwent TJA were identified. Of these, 44,370 (4.5%) had Medicaid. Of the patients undergoing TJA, 46.4% of those with Medicaid were treated by surgeons performing ≤100 TJA cases annually compared with 34.3% of those without Medicaid. Furthermore, a higher percentage of patients with Medicaid underwent TJA at lower-volume hospitals performing ≤500 cases annually, 50.8% compared with 35.5% for patients without Medicaid. After accounting for differences among the 2 cohorts, patients with Medicaid remained at increased risk for postoperative deep vein thrombosis (adjusted odds ratio [OR], 1.16; p = 0.031), pulmonary embolism (adjusted OR, 1.39; p < 0.001), periprosthetic joint infection (adjusted OR, 1.35; p < 0.001), and 90-day readmission (adjusted OR, 1.25; p < 0.001).
Patients with Medicaid were more likely to undergo TJA performed by lower-volume surgeons at lower-volume hospitals and had higher rates of postoperative complications compared with patients without Medicaid. Future research should assess socioeconomic status, insurance, and postoperative outcomes in this vulnerable patient population seeking arthroplasty care.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
与没有 Medicaid 保险的患者相比，接受全髋关节置换术 (THA) 或全膝关节置换术 (TKA) 的 Medicaid 保险患者的术后结局更差。每年全关节置换术 (TJA) 量较低的外科医生和医院也与较差的结果相关。本研究旨在描述 Medicaid 保险状态、外科医生手术量和医院手术量之间的关联，并评估与其他支付类型相比术后并发症的发生率。
使用 Premier Healthcare Database 数据库查询了 2016 年至 2019 年期间接受初次 TJA 的所有成年患者。患者根据保险状况分为 Medicaid 和非 Medicaid。评估了每个队列中每年医院和外科医生病例量的分布。进行了多变量分析，以根据患者人口统计学特征、合并症、外科医生数量和医院数量评估按保险状况计算的 90 天内术后并发症的风险。
共确定了 986,230 例接受 TJA 的患者。其中，44,370 例（4.5%）有 Medicaid。在接受 TJA 的患者中，46.4%的 Medicaid 患者由每年手术量≤100 例的外科医生治疗，而非 Medicaid 患者为 34.3%。此外，更多的 Medicaid 患者在每年手术量≤500 例的低容量医院接受 TJA，占 50.8%，而非 Medicaid 患者为 35.5%。在考虑了两个队列之间的差异后， Medicaid 患者仍有较高的术后深静脉血栓形成风险（调整后比值比 [OR]，1.16；p = 0.031）、肺栓塞（调整后 OR，1.39；p < 0.001）、假体周围关节感染（调整后 OR，1.35；p < 0.001）和 90 天再入院（调整后 OR，1.25；p < 0.001）。
与没有 Medicaid 保险的患者相比， Medicaid 患者更有可能接受低容量外科医生进行的 TJA，并在低容量医院进行治疗，且术后并发症发生率较高。未来的研究应评估寻求关节置换治疗的这一弱势群体患者的社会经济地位、保险和术后结果。
预后 III 级。有关证据水平的完整描述，请参阅作者说明。
