Wang Jennifer C, Liu Kevin C, Gettleman Brandon S, Piple Amit S, Chen Matthew S, Menendez Lawrence R, Heckmann Nathanael D, Christ Alexander B
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA.
Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, SC 29209, USA.
J Clin Med. 2023 Aug 4;12(15):5122. doi: 10.3390/jcm12155122.
Medicare Advantage healthcare plans may present undue impediments that result in disparities in patient outcomes. This study aims to compare the outcomes of patients who underwent STS resection based on enrollment in either traditional Medicare (TM) or Medicare Advantage (MA) plans. The Premier Healthcare Database was utilized to identify all patients ≥65 years old who underwent surgery for resection of a lower-extremity STS from 2015 to 2021. These patients were then subdivided based on their Medicare enrollment status (i.e., TM or MA). Patient characteristics, hospital factors, and comorbidities were recorded for each cohort. Bivariable analysis was performed to assess the 90-day risk of postoperative complications. Multivariable analysis controlling for patient sex, as well as demographic and hospital factors found to be significantly different between the cohorts, was also performed. From 2015 to 2021, 1858 patients underwent resection of STS. Of these, 595 (32.0%) had MA coverage and 1048 (56.4%) had TM coverage. The only comorbidities with a significant difference between the cohorts were peripheral vascular disease ( = 0.027) and hypothyroidism ( = 0.022), both with greater frequency in MA patients. After controlling for confounders, MA trended towards having significantly higher odds of pulmonary embolism (adjusted odds ratio (aOR): 1.98, 95% confidence interval (95%-CI): 0.58-6.79), stroke (aOR: 1.14, 95%-CI: 0.20-6.31), surgical site infection (aOR: 1.59, 95%-CI: 0.75-3.37), and 90-day in-hospital death (aOR 1.38, 95%-CI: 0.60-3.19). Overall, statistically significant differences in postoperative outcomes were not achieved in this study. The authors of this study hypothesize that this may be due to study underpowering or the inability to control for other oncologic factors not available in the Premier database. Further research with higher power, such as through multi-institutional collaboration, is warranted to better assess if there truly are no differences in outcomes by Medicare subtype for this patient population.
医疗保险优势医疗计划可能会带来不当阻碍，导致患者治疗结果出现差异。本研究旨在比较根据传统医疗保险（TM）或医疗保险优势（MA）计划参保情况接受肢体软组织肉瘤（STS）切除术的患者的治疗结果。利用Premier医疗数据库识别2015年至2021年期间所有65岁及以上接受下肢STS切除术的患者。然后根据他们的医疗保险参保状态（即TM或MA）对这些患者进行细分。记录每个队列的患者特征、医院因素和合并症。进行双变量分析以评估术后并发症的90天风险。还进行了多变量分析，控制患者性别以及在队列之间发现有显著差异的人口统计学和医院因素。2015年至2021年期间，1858例患者接受了STS切除术。其中，595例（32.0%）有MA保险，1048例（56.4%）有TM保险。队列之间唯一有显著差异的合并症是外周血管疾病（P = 0.027）和甲状腺功能减退症（P = 0.022），两者在MA患者中的发生率更高。在控制混杂因素后，MA患者发生肺栓塞（调整优势比（aOR）：1.98，95%置信区间（95%-CI）：0.58-6.79）、中风（aOR：1.14，95%-CI：0.20-6.31）、手术部位感染（aOR：1.59，95%-CI：0.75-3.37）和90天内住院死亡（aOR 1.38，95%-CI：0.60-3.19）的几率有升高趋势。总体而言，本研究未实现术后结果的统计学显著差异。本研究的作者推测，这可能是由于研究效能不足或无法控制Premier数据库中未提供的其他肿瘤学因素。有必要通过多机构合作等更高效能的进一步研究，以更好地评估该患者群体按医疗保险亚型划分的治疗结果是否真的没有差异。
