Medicaid patients undergoing total joint arthroplasty at lower volume hospitals by lower volume surgeons associated with poorer outcomes
Location
LSUHSC Center for Advanced Learning and Simulation
Document Type
Presentation
Start Date
22-6-2024 8:45 AM
End Date
22-6-2024 9:05 AM
Publication Date
June 2024
Description
Introduction: Medicaid insurance coverage amongst total hip (THA) and knee arthroplasty (TKA) patients has been associated with worse postoperative outcomes compared with non- Medicaid patients. Surgeons and hospitals with lower annual total joint arthroplasty (TJA) volume have also been associated with worse outcomes. This study sought to characterize the associations between Medicaid insurance status, surgeon case volume, and hospital case volume, and assess rates of postoperative complications compared with other payer types.
Methods: The Premier Database was queried for all adult patients who underwent primary TJA from 2016-2019. Patients were divided based on their insurance status: Medicaid vs. non- Medicaid. The distribution of annual hospital and surgeon case volume was assessed for each cohort. Multivariate analyses were performed accounting for patient demographics, comorbidities, surgeon volume, and hospital volume to assess the 90-day risk of postoperative complications by insurance status.
Results: Overall, 986,230 TJA patients were identified. Of these, 44,370 (4.50%) had Medicaid. In total, 46.4% of Medicaid patients undergoing TJA were treated by surgeons performing <100 TJA cases annually compared to 34.4% of non-Medicaid patients. Furthermore, Medicaid patients were more likely to undergo TJA at lower volume hospitals performing <500 cases annually compared to non-Medicaid patients (50.8% vs. 35.5%). After accounting for differences amongst the two cohorts, Medicaid patients remained at increased risk for postoperative deep venous thrombosis (adjusted odds ratio [aOR] 1.16, p=0.031), pulmonary embolism (aOR 1.39, p<0.001), periprosthetic joint infection (aOR 1.35, p<0.001), and 90-day readmission (aOR 1.25, p<0.001).
Conclusion: Medicaid patients were more likely to undergo TJA by lower volume surgeons at lower volume hospitals and had higher rates of postoperative complications compared to non- Medicaid patients. Future research should assess socioeconomic status, insurance, and postoperative outcomes in this vulnerable patient population seeking arthroplasty care.
Recommended Citation
Hansen, Charles W., "Medicaid patients undergoing total joint arthroplasty at lower volume hospitals by lower volume surgeons associated with poorer outcomes" (2024). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 3.
https://digitalscholar.lsuhsc.edu/ortho_rd/2024/presentation1/3
Medicaid patients undergoing total joint arthroplasty at lower volume hospitals by lower volume surgeons associated with poorer outcomes
LSUHSC Center for Advanced Learning and Simulation
Introduction: Medicaid insurance coverage amongst total hip (THA) and knee arthroplasty (TKA) patients has been associated with worse postoperative outcomes compared with non- Medicaid patients. Surgeons and hospitals with lower annual total joint arthroplasty (TJA) volume have also been associated with worse outcomes. This study sought to characterize the associations between Medicaid insurance status, surgeon case volume, and hospital case volume, and assess rates of postoperative complications compared with other payer types.
Methods: The Premier Database was queried for all adult patients who underwent primary TJA from 2016-2019. Patients were divided based on their insurance status: Medicaid vs. non- Medicaid. The distribution of annual hospital and surgeon case volume was assessed for each cohort. Multivariate analyses were performed accounting for patient demographics, comorbidities, surgeon volume, and hospital volume to assess the 90-day risk of postoperative complications by insurance status.
Results: Overall, 986,230 TJA patients were identified. Of these, 44,370 (4.50%) had Medicaid. In total, 46.4% of Medicaid patients undergoing TJA were treated by surgeons performing <100 TJA cases annually compared to>34.4% of non-Medicaid patients. Furthermore, Medicaid patients were more likely to undergo TJA at lower volume hospitals performing <500 cases annually compared to non-Medicaid patients>(50.8% vs. 35.5%). After accounting for differences amongst the two cohorts, Medicaid patients remained at increased risk for postoperative deep venous thrombosis (adjusted odds ratio [aOR] 1.16, p=0.031), pulmonary embolism (aOR 1.39, p<0.001), periprosthetic joint infection (aOR 1.35, p<0.001), and 90-day readmission (aOR 1.25, p<0.001).
Conclusion: Medicaid patients were more likely to undergo TJA by lower volume surgeons at lower volume hospitals and had higher rates of postoperative complications compared to non- Medicaid patients. Future research should assess socioeconomic status, insurance, and postoperative outcomes in this vulnerable patient population seeking arthroplasty care.