Medicaid insurance status predicts postoperative mortality after total knee arthroplasty in state inpatient databases

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Public Health

Background:

• Insurance status is a critical determinant of healthcare access and outcomes.
• Understanding disparities in outcomes after total knee arthroplasty (TKA) is essential for improving patient care.
• Previous research suggests socioeconomic factors influence surgical outcomes.

Purpose of the Study:

• To investigate the association between primary insurance status (Medicaid vs. private) and in-hospital outcomes following primary total knee arthroplasty (TKA).
• To determine if Medicaid insurance predicts increased mortality, morbidity, length of stay, and total charges after TKA.

Main Methods:

• Retrospective analysis of the State Inpatient Database (SID) from five states.
• Inclusion of adult patients who underwent primary TKA between January 2007 and December 2014.
• Use of regression models to compare outcomes between Medicaid and privately insured patients.

Main Results:

• Medicaid patients demonstrated significantly greater odds of in-hospital mortality (OR: 1.73).
• Increased odds of any postoperative complications were observed in Medicaid patients (OR: 1.25).
• Medicaid status was associated with longer lengths of stay (OR: 1.09) and higher total charges (OR: 1.03).

Conclusions:

• Medicaid insurance is independently associated with adverse in-hospital outcomes after TKA.
• Findings highlight potential healthcare disparities for TKA patients with Medicaid.
• Further research is warranted to explore mechanisms and interventions to mitigate these disparities.