Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

Area of Science:

• Orthopaedic Surgery
• Health Services Research
• Public Health

Background:

• Patients with public insurance, such as Medicaid, often encounter barriers to timely orthopaedic care.
• Delayed treatment for recurrent traumatic anterior shoulder instability can exacerbate bone loss and necessitate more complex surgical interventions.

Purpose of the Study:

• To compare treatment outcomes for shoulder instability between patients with Medicaid and those with non-Medicaid insurance.
• To investigate if Medicaid patients experience longer delays, a greater history of instability, increased bone loss, and require more extensive surgical procedures.

Main Methods:

• A cohort study (Level of evidence, 3) reviewed records of 206 patients undergoing surgical stabilization for traumatic anterior shoulder instability.
• Data collected included insurance type, instability episodes, time to surgery, glenoid bone loss, and surgical procedure performed.

Main Results:

• Medicaid patients waited an average of 1640 days for surgery versus 1237 days for others (P = .005).
• Medicaid patients were more likely to have had 5+ instability events (OR, 3.3), significant glenoid bone loss (OR, 3.5), and require open stabilization (OR, 3.0).

Conclusions:

• Patients with Medicaid insurance experienced significantly longer delays in receiving surgical care for traumatic anterior shoulder instability.
• These delays correlated with a more extensive history of instability, greater bone loss, and the need for more invasive surgical procedures.