Medicaid Payer Status Is Associated with In-Hospital Morbidity and Resource Utilization Following Primary Total Joint Arthroplasty

被引:106
作者
Browne, James A. [1 ]
Novicoff, Wendy M. [1 ]
D'Apuzzo, Michele R. [1 ]
机构
[1] Univ Virginia, Dept Orthopaed Surg, Charlottesville, VA 22908 USA
关键词
KNEE ARTHROPLASTY; RISK-FACTORS; OUTCOMES; HIP; MORTALITY; REVISION; RATES; CARE; IMPACT;
D O I
10.2106/JBJS.N.00133
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Previous reports suggest that there are major disparities in outcomes following total joint arthroplasty among patients with different payer statuses. The explanation for these differences is largely unknown and may result from confounding variables. The Affordable Care Act expansion of Medicaid coverage in 2014 makes the examination of these disparities particularly relevant. Methods: The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database was used to identify patients who had undergone primary hip or knee arthroplasty from 2002 through 2011. Complications, costs, and length of hospital stay for patients with Medicaid were compared with those for non-Medicaid patients. Each Medicaid patient was matched to a non-Medicaid patient according to age, sex, race, type of total joint arthroplasty, procedure year, hospital characteristics, smoking status, and all twenty-nine comorbidities defined in the NIS-modified Elixhauser comorbidity measure. Results: It was determined that 191,911 patients who underwent total joint arthroplasty had Medicaid payer status (2.8% of the entire total joint arthroplasty population), and 107,335 (56%) of these Medicaid patients were matched one to one to a non-Medicaid patient for all variables for the adjusted analysis. After matching, Medicaid patients were found to have a higher prevalence of postoperative in-hospital infection (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3 to 2.1), wound dehiscence (OR, 2.2; 95% CI, 1.4 to 3.4), and hematoma or seroma (OR, 1.3; 95% CI, 1.2 to 1.4) but a lower risk of cardiac complications (OR, 0.7; CI, 0.6 to 0.9). The length of the hospital stay was longer, total cost was higher, and discharge to an inpatient facility was more frequent for patients with Medicaid status (p < 0.01). Conclusions: Compared with non-Medicaid patients, Medicaid patients have a significantly higher risk for certain postoperative in-hospital complications and consume more resources following total joint arthroplasty even when the two groups have been matched for patient-related factors and comorbid conditions commonly associated with low socioeconomic status. Additional work is needed to understand the complex interplay between socioeconomic status and outcomes, to ensure appropriate resources are allocated to maintain access for this patient population, and to develop appropriate risk stratification.
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页数:6
相关论文
共 29 条
[1]   Influence of patients' socioeconomic status on clinical management decisions: A qualitative study [J].
Bernheim, Susannah M. ;
Ross, Joseph S. ;
Krumholz, Harlan M. ;
Bradley, Elizabeth H. .
ANNALS OF FAMILY MEDICINE, 2008, 6 (01) :53-59
[2]   cem: Coarsened exact matching in Stata [J].
Blackwell, Matthew ;
Iacus, Stefano ;
King, Gary ;
Porro, Giuseppe .
STATA JOURNAL, 2009, 9 (04) :524-546
[3]   The Epidemiology of Revision Total Knee Arthroplasty in the United States [J].
Bozic, Kevin J. ;
Kurtz, Steven M. ;
Lau, Edmund ;
Ong, Kevin ;
Chiu, Vanessa ;
Vail, Thomas P. ;
Rubash, Harry E. ;
Berry, Daniel J. .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2010, 468 (01) :45-51
[4]   The Epidemiology of Revision Total Hip Arthroplasty in the United States [J].
Bozic, Kevin J. ;
Kurtz, Steven M. ;
Lau, Edmund ;
Ong, Kevin ;
Vail, Thomas P. ;
Berry, Daniel J. .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2009, 91A (01) :128-133
[5]   Depression Is Associated With Early Postoperative Outcomes Following Total Joint Arthroplasty: A Nationwide Database Study [J].
Browne, James A. ;
Sandberg, Benjamin F. ;
D'Apuzzo, Michele R. ;
Novicoff, Wendy M. .
JOURNAL OF ARTHROPLASTY, 2014, 29 (03) :481-483
[6]   Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review [J].
Calvillo-King, Linda ;
Arnold, Danielle ;
Eubank, Kathryn J. ;
Lo, Matthew ;
Yunyongying, Pete ;
Stieglitz, Heather ;
Halm, Ethan A. .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2013, 28 (02) :269-282
[7]   Payer status and the utilization of hospital resources in acute myocardial infarction -: A report from the National Registry of Myocardial Infarction 2 [J].
Canto, JG ;
Rogers, WJ ;
French, WJ ;
Gore, JM ;
Chandra, NC ;
Barron, HV .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (06) :817-823
[8]  
Chu A, 2009, J STAT SOFTW, V30, P1
[9]  
COHEN JW, 1989, HEALTH SERV RES, V24, P33
[10]   Risk Factors for Early Revision After Total Hip Arthroplasty [J].
Dy, Christopher J. ;
Bozic, Kevin J. ;
Pan, Ting Jung ;
Wright, Timothy M. ;
Padgett, Douglas E. ;
Lyman, Stephen .
ARTHRITIS CARE & RESEARCH, 2014, 66 (06) :907-915