Richardson Mary K, Wier Julian, Bruce Dara, Liu Kevin C, Cohen-Rosenblum Anna, Lieberman Jay R, Heckmann Nathanael D
From the Keck Medical Center of the University of Southern California, Los Angeles, CA (Richardson, Wier, Bruce, Liu, Lieberman, and Heckmann), and the Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA (Cohen-Rosenblum).
J Am Acad Orthop Surg. 2025 Apr 1;33(7):e391-e400. doi: 10.5435/JAAOS-D-24-00165. Epub 2024 Dec 3.
Patients with Medicaid insurance are at an increased risk of postoperative complications following total knee arthroplasty and total hip arthroplasty (TJA); however, their outcomes following revision TJA for periprosthetic joint infection (PJI) requires further study.
A retrospective query was conducted for adult patients undergoing implant explantation and antibiotic spacer placement for TJA PJI from the Premier Healthcare Database between December 1, 2016, and December 31, 2021. Patients were then grouped by Medicaid or non-Medicaid insurance status and were age matched through exact caliper matching. Multivariable regression models addressed potential confounding. Adjusted risks of 90-day postoperative complications were reported.
Of the 40,346 patients identified, 2,711 Medicaid patients were matched to 10,844 non-Medicaid patients on age (56.1 vs. 56.1 years, P = 1.000). Patients with Medicaid experienced higher risk of sepsis (adjusted odds ratio [aOR] = 1.20, P = 0.010), readmission (aOR = 1.12, P = 0.022), being discharged to a skilled nursing facility (aOR = 1.13, P = 0.031), and had longer length of stay (9.48 vs. 6.67 days, P < 0.001), compared with patients with non-Medicaid. Medicaid patients had a higher rate of inpatient mortality (0.81% vs. 0.48%, P = 0.038); however, the risk was similar after accounting for differences in comorbidities.
Following revision TJA for PJI, patients with Medicaid were at an increased risk for postoperative complication, including sepsis and readmission. They experienced a higher rate of inpatient mortality that may be driven by differences in comorbidities. Insurers and policy makers should consider this information to develop risk stratification-based payment strategies that take into account the healthcare burden of this high-risk patient population.
IV.
接受全膝关节置换术和全髋关节置换术（TJA）的医疗补助保险患者术后并发症风险增加；然而，他们因假体周围关节感染（PJI）接受翻修TJA后的结局需要进一步研究。
对2016年12月1日至2021年12月31日期间在Premier医疗数据库中因TJA PJI接受植入物取出和抗生素间隔物置入的成年患者进行回顾性查询。然后根据医疗补助保险或非医疗补助保险状态对患者进行分组，并通过精确卡尺匹配进行年龄匹配。多变量回归模型处理潜在的混杂因素。报告术后90天并发症的调整风险。
在确定的40346例患者中，2711例医疗补助患者与10844例非医疗补助患者年龄匹配（56.1岁对56.1岁，P = 1.000）。与非医疗补助患者相比，医疗补助患者发生败血症的风险更高（调整优势比[aOR]=1.20，P = 0.010）、再次入院风险更高（aOR = 1.12，P = 0.022）、出院到专业护理机构的风险更高（aOR = 1.13，P = 0.031），住院时间更长（9.48天对6.67天，P < 0.001）。医疗补助患者的住院死亡率更高（0.81%对0.48%，P = 0.038）；然而，在考虑合并症差异后风险相似。
因PJI接受翻修TJA后，医疗补助患者术后并发症风险增加，包括败血症和再次入院。他们的住院死亡率更高，这可能是由合并症差异导致的。保险公司和政策制定者应考虑这些信息，以制定基于风险分层的支付策略，同时考虑到这一高风险患者群体的医疗负担。
IV级。
