Heckmann Nathanael D, Wier Julian, Liu Kevin C, Richardson Mary K, Vega Andrew N, Bedard Nicholas A, Berry Daniel J, Callaghan John J, Lieberman Jay R
Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2025 Apr;40(4):854-859.e6. doi: 10.1016/j.arth.2024.10.010. Epub 2024 Oct 16.
Privatized Medicare Advantage (MA) plans are an alternative to traditional Medicare (TM). We sought to identify differences in 90-day postoperative mortality and nonfatal adverse events between TM and MA patients undergoing stage 1 antibiotic spacer placement for periprosthetic joint infection (PJI) of the hip or knee.
A nationally representative database was queried from 2015 to 2021 for adult patients undergoing stage 1 antibiotic spacer placement for PJI. Using the International Classification of Disease, 10th Revision, and Current Procedural Terminology codes, as well as hospital charges for antibiotics, patients undergoing stage 1 exchange arthroplasty for PJI were identified. Patients were then grouped into TM and MA cohorts. The primary outcome was the odds of 90-day mortality. Multivariable logistic regressions were conducted to address possible confounding demographic, comorbidity, and hospital characteristics.
Of the 40,346 patients undergoing stage 1 spacer placement for PJI, 16,637 (41.2%) had TM coverage and 9,218 (22.8%) had MA coverage. Mortality within 90 days of surgery was higher in the MA cohort (1.4% versus 1.0%, P = 0.004). Multivariable logistic regression demonstrated significantly higher adjusted odds of mortality (adjusted odds ratio = 1.42, 95% confidence interval = 1.11 to 1.81, P = 0.005) in MA patients compared to TM.
Even after accounting for available confounders with our multivariable analyses, patients enrolled in an MA plan were more than 40% more likely to die within 90 days of surgery compared to patients who have TM coverage. Further study is necessary to better understand the underlying cause of this finding.
私营医疗保险优势（MA）计划是传统医疗保险（TM）的一种替代方案。我们试图确定接受髋关节或膝关节假体周围感染（PJI）一期抗生素间隔物置入的TM和MA患者在术后90天死亡率和非致命不良事件方面的差异。
查询2015年至2021年全国代表性数据库，以获取接受PJI一期抗生素间隔物置入的成年患者信息。使用国际疾病分类第10版和当前程序术语编码，以及抗生素的医院收费情况，确定接受PJI一期关节置换术的患者。然后将患者分为TM和MA队列。主要结局是90天死亡率的比值。进行多变量逻辑回归以解决可能存在的人口统计学、合并症和医院特征方面的混杂因素。
在40346例接受PJI一期间隔物置入的患者中，16637例（41.2%）有TM保险，9218例（22.8%）有MA保险。MA队列中术后90天内的死亡率更高（1.4%对1.0%，P = 0.004）。多变量逻辑回归显示，与TM患者相比，MA患者调整后的死亡几率显著更高（调整后的优势比 = 1.42，95%置信区间 = 1.11至1.81，P = 0.005）。
即使在我们的多变量分析中考虑了可用的混杂因素，与有TM保险的患者相比，参加MA计划的患者在术后90天内死亡的可能性仍高出40%以上。有必要进行进一步研究以更好地理解这一发现的潜在原因。
