Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
Arthroscopy. 2024 Apr;40(4):1117-1125. doi: 10.1016/j.arthro.2023.08.011. Epub 2023 Aug 18.
To compare 90-day complications, 30-day emergency department (ED) visits, and 5-year rate of secondary surgeries for patients with Medicaid vs commercial insurance undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and/or labral tears using a large national database.
The PearlDiver Mariner151 database was used to identify patients with International Classification of Diseases, Tenth Revision diagnosis codes for FAIS and/or labral tear who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021. Patients with Medicaid were matched 1:4 to a control group of commercially insured patients based on age, sex, body mass index, and Elixhauser Comorbidity Index. Rates of 90-day complications and 30-day ED visits were compared using multivariate regression models. Five-year rates of secondary surgeries-revision arthroscopy or total hip arthroplasty-were compared between cohorts by Kaplan-Meier analysis.
A total of 2,033 Medicaid patients were matched with 8,056 commercially insured patients. Rates of adverse events were low; however, Medicaid patients were significantly more likely than commercially insured patients to experience any 90-day complication (2.12% vs 1.43%; odds ratio [OR], 1.2; P = .02). Medicaid patients also experienced more 30-day ED visits than commercially insured patients (8.61% vs 4.28%), and on multivariate logistic regression, insurance status was the strongest determinant of 30-day ED visits (relative to commercial, Medicaid OR, 2.02; P < .001). Despite these differences, 5-year rates of secondary surgeries were comparable between groups (6.1% vs 6.0%; P = .6).
In this large national database study, Medicaid patients undergoing primary hip arthroscopy showed significantly greater odds of experiencing 90-day postoperative complications and 30-day ED visits compared to commercially insured patients. Nevertheless, both groups had similar survivorship rates at 5-year follow-up, similar to prior estimates irrespective of insurance. These results document encouraging secondary surgery rates in Medicaid patients.
使用大型国家数据库比较接受初次髋关节镜检查治疗股骨髋臼撞击综合征（FAIS）和/或盂唇撕裂的医疗补助和商业保险患者的 90 天并发症、30 天急诊就诊率和 5 年二次手术率。
使用 PearlDiver Mariner151 数据库确定在 2015 年至 2021 年期间接受过股骨成形术、髋臼成形术和/或盂唇修复术的 FAIS 和/或盂唇撕裂国际疾病分类，第十版诊断代码的患者。根据年龄、性别、体重指数和 Elixhauser 合并症指数，将 Medicaid 患者与商业保险对照组患者 1:4 匹配。使用多元回归模型比较 90 天并发症和 30 天急诊就诊率。通过 Kaplan-Meier 分析比较两组患者的 5 年二次手术（翻修关节镜或全髋关节置换术）率。
共有 2033 名 Medicaid 患者与 8056 名商业保险患者相匹配。不良事件发生率较低；然而，与商业保险患者相比， Medicaid 患者更有可能经历任何 90 天并发症（2.12% vs 1.43%；比值比[OR]，1.2；P=.02）。 Medicaid 患者也比商业保险患者经历更多的 30 天急诊就诊（8.61% vs 4.28%），并且在多变量逻辑回归中，保险状况是 30 天急诊就诊的最强决定因素（与商业保险相比， Medicaid 的 OR，2.02；P <.001）。尽管存在这些差异，但两组的 5 年二次手术率相当（6.1% vs 6.0%；P=.6）。
在这项大型国家数据库研究中，与商业保险患者相比，接受初次髋关节镜检查治疗的 Medicaid 患者经历 90 天术后并发症和 30 天急诊就诊的几率明显更高。然而，两组患者在 5 年随访时的生存率相似，与保险无关，与先前的估计相似。这些结果记录了 Medicaid 患者令人鼓舞的二次手术率。
