Calem Daniel B, Weintraub Matthew, Joshi Tej, Sudah Suleiman Y, Alberta Francis, Kohan Eitan M
Department of Orthopaedic Surgery, Rutgers Health New Jersey Medical School, Newark, NJ, USA.
Department of Orthopaedic Surgery, Rutgers Health New Jersey Medical School, Newark, NJ, USA.
J Shoulder Elbow Surg. 2025 Aug;34(8):2037-2043. doi: 10.1016/j.jse.2024.11.020. Epub 2025 Jan 9.
Acromioclavicular (AC) joint injury management has historically been guided by the severity and grade of the injury. However, recent debates have emerged regarding the role of surgical intervention for these injuries. Insurance-based disparities in surgical treatment have been well-documented across various orthopedic conditions. This study seeks to determine whether insurance coverage influences the likelihood of undergoing surgical fixation for AC joint dislocation.
We conducted a retrospective analysis of the National Readmissions Database spanning from 2016 to 2021. Using International Classification of Diseases, 10th Revision codes, we identified patients with isolated AC joint dislocation and determined whether they received surgical intervention based on International Classification of Diseases, 10th Revision procedural codes. A total of 5654 cases of AC joint dislocation were identified, of which 219 (3.9%) underwent operative management. Statistical analysis was conducted via univariate analysis using Pearson's chi-square test, followed by multivariable logistic regression to assess the significance of demographic and socioeconomic factors on likelihood of operative intervention. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).
After adjusting for demographic and socioeconomic variables including age, sex, income quartile, and medical comorbidities, patients with Medicaid insurance were significantly less likely to receive surgical intervention for AC joint dislocation compared to those with private insurance (OR 0.51; 95% CI 0.34-0.76; P < .01). Furthermore, individuals residing in areas with the highest income quartile by ZIP code exhibited the greatest likelihood of undergoing surgery (OR 1.91; 95% CI 1.27-2.89; P < .01), in contrast to those in lower income areas.
This study suggests that patients insured by Medicaid are less likely to undergo surgery for AC joint injury compared to those with private insurance. Additionally, patients from higher income areas were more likely to receive operative treatment. These findings emphasize the need for more standardized treatment guidelines, particularly as the controversy surrounding operative vs. nonoperative management of these injuries persists, and no definitive gold standard surgical technique exists. Surgeons must remain vigilant of these biases that may influence clinical decision-making.
肩锁关节（AC）损伤的治疗历来是根据损伤的严重程度和分级来指导的。然而，最近关于这些损伤手术干预作用的争论已经出现。在各种骨科疾病中，基于保险的手术治疗差异已有充分记录。本研究旨在确定保险覆盖范围是否会影响肩锁关节脱位接受手术固定的可能性。
我们对2016年至2021年的国家再入院数据库进行了回顾性分析。使用国际疾病分类第十版编码，我们确定了孤立性肩锁关节脱位的患者，并根据国际疾病分类第十版手术编码确定他们是否接受了手术干预。共识别出5654例肩锁关节脱位病例，其中219例（3.9%）接受了手术治疗。通过使用Pearson卡方检验进行单变量分析，随后进行多变量逻辑回归分析，以评估人口统计学和社会经济因素对手术干预可能性的显著性。结果以比值比（OR）和95%置信区间（CI）表示。
在调整了包括年龄、性别、收入四分位数和医疗合并症等人口统计学和社会经济变量后，与拥有私人保险的患者相比，参加医疗补助保险的患者接受肩锁关节脱位手术干预的可能性显著降低（OR 0.51；95% CI 0.34 - 0.76；P <.01）。此外，按邮政编码划分居住在收入四分位数最高地区的个体接受手术的可能性最大（OR 1.91；95% CI 1.27 - 2.89；P <.01），与低收入地区的个体形成对比。
本研究表明，与拥有私人保险的患者相比，参加医疗补助保险的患者接受肩锁关节损伤手术的可能性较小。此外，来自高收入地区的患者更有可能接受手术治疗。这些发现强调了需要更标准化的治疗指南，特别是鉴于围绕这些损伤手术与非手术治疗的争议仍然存在，且不存在明确的金标准手术技术。外科医生必须警惕这些可能影响临床决策的偏差。
