Carpenter Melissa L, Murray Michael J, Poulson Trevor A, Haynes Monique, Mamonov Alexander, Villarreal-Espinosa Juan Bernardo, Chahla Jorge, Verma Nikhil N
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthrosc Sports Med Rehabil. 2025 Apr 14;7(3):101148. doi: 10.1016/j.asmr.2025.101148. eCollection 2025 Jun.
To determine whether patients insured through Medicaid exhibit differences in patient-reported outcomes, functional measurements, reinjury, and reoperation metrics after primary rotator cuff repair compared with patients insured with private insurance.
All skeletally mature patients insured through Medicaid who had undergone a primary rotator cuff repair from January 2014 to July 2023 were identified and compared with a matched cohort of patients with private insurance. Patients were excluded if they were undergoing a revision procedure, had a history of shoulder infection, did not have completed medical records or baseline patient-reported outcome measures, or were lost to follow-up before 1 year postoperatively. Patients were provided questionnaires containing the American Shoulder and Elbow Surgeons (ASES) score, the Veterans RAND 12-Item Health Survey (VR-12), and reinjury and reoperation metrics. Physical therapy (PT) and clinic notes were also reviewed to determine the number of PT visits attended, number of PT visits missed, distance from patients' home address to the PT facility, range of motion, and comorbidities.
A total of 16 patients insured through Medicaid and 16 insured through private insurance were enrolled in this study. There was no difference in average follow-up time between the 2 groups (31.1 vs 38.4 months; = .391). The 2 groups showed no differences in age, body mass index, sex, smoking status, or other comorbidities, including diabetes, hypertension, and depression. The Medicaid group had a significantly lower preoperative ASES (29.86 vs 46.28; = .008). Patients insured through Medicaid also had a significantly lower postoperative VR-12 Mental Score (38.20 vs 53.40; = .013). There was no significant difference in preoperative or postoperative forward flexion or external rotation between the 2 groups. The average distance from home to PT facility, the number of postoperative PT sessions attended and missed, and reinjury and reoperation rates were also similar between groups. Both groups attained the minimal clinically important difference for ASES and VR-12 Physical but not VR-12 Mental.
Despite Medicaid patients having a lower ASES preoperatively, they showed no difference in functional outcomes compared to patients with private insurance at final follow-up. However, patients with Medicaid had a significantly lower postoperative VR-12 Mental score, which requires further exploration.
Level III, retrospective comparative study.
确定与私人保险参保患者相比，医疗补助保险参保患者在初次肩袖修复术后患者报告的结局、功能测量、再次受伤及再次手术指标方面是否存在差异。
确定2014年1月至2023年7月期间接受初次肩袖修复术的所有骨骼成熟的医疗补助保险参保患者，并与匹配的私人保险参保患者队列进行比较。如果患者正在接受翻修手术、有肩部感染史、没有完整的病历或基线患者报告的结局测量数据，或在术后1年之前失访，则将其排除。为患者提供包含美国肩肘外科医师（ASES）评分、退伍军人兰德12项健康调查（VR - 12）以及再次受伤和再次手术指标的问卷。还查阅了物理治疗（PT）记录和临床记录，以确定参加PT治疗的次数、错过的PT治疗次数、患者家庭住址到PT机构的距离、活动范围和合并症。
本研究共纳入16名医疗补助保险参保患者和16名私人保险参保患者。两组的平均随访时间无差异（31.1个月对38.4个月；P = 0.391）。两组在年龄、体重指数、性别、吸烟状况或其他合并症（包括糖尿病、高血压和抑郁症）方面无差异。医疗补助保险组术前ASES评分显著更低（29.86对46.28；P = 0.00）。医疗补助保险参保患者术后VR - 12心理评分也显著更低（38.20对53.40；P = 0.013）。两组术前或术后的前屈或外旋无显著差异。两组从家到PT机构的平均距离、术后参加和错过的PT治疗次数以及再次受伤和再次手术率也相似。两组在ASES和VR - 12身体评分方面均达到了最小临床重要差异，但在VR - 12心理评分方面未达到。
尽管医疗补助保险患者术前ASES评分较低，但在最终随访时，与私人保险患者相比，他们在功能结局方面无差异。然而，医疗补助保险患者术后VR - 12心理评分显著更低，这需要进一步探究。
三级，回顾性比较研究。
