Related Experiment Video
Updated: Aug 15, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Medicaid payer status is associated with in-hospital morbidity and resource utilization following primary total joint
James A Browne1, Wendy M Novicoff1, Michele R D'Apuzzo2
1Department of Orthopaedic Surgery, University of Virginia, P.O. Box 800159, Charlottesville, VA 22908. E-mail address for J.A. Browne: jamesbrowne@virginia.edu.
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.
Insights
Patients with Medicaid coverage experience higher risks of certain complications and increased resource use after total joint arthroplasty. This highlights disparities in healthcare outcomes for this population.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Health Economics
Background:
- Significant disparities in total joint arthroplasty outcomes exist based on patient payer status.
- The reasons for these outcome differences remain largely unexplained and may be influenced by confounding variables.
- The expansion of Medicaid coverage under the Affordable Care Act necessitates an examination of these payer-based disparities.
Purpose of the Study:
- To compare postoperative complications, costs, and hospital length of stay between Medicaid and non-Medicaid patients undergoing total joint arthroplasty.
- To investigate potential disparities in total joint arthroplasty outcomes stratified by payer status.
- To provide data relevant to resource allocation and risk stratification for vulnerable patient populations.
Main Methods:
- Utilized the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database.
- Included patients who underwent primary hip or knee arthroplasty between 2002 and 2011.
- Employed one-to-one matching to compare Medicaid patients with non-Medicaid patients on numerous demographic, clinical, and hospital-related variables.
Main Results:
- Medicaid patients demonstrated higher rates of in-hospital infection, wound dehiscence, and hematoma/seroma.
- A lower risk of cardiac complications was observed in Medicaid patients.
- Medicaid patients experienced longer hospital stays, higher total costs, and more frequent discharges to inpatient facilities.
Conclusions:
- Medicaid patients face increased risks for specific postoperative complications and higher resource consumption post-total joint arthroplasty, even after controlling for patient factors and comorbidities.
- Further research is required to elucidate the complex relationship between socioeconomic status and surgical outcomes.
- Strategies for resource allocation and risk stratification are needed to ensure equitable care for the Medicaid population undergoing joint replacement surgery.
More Related Videos
09:31Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
