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Medicaid Insurance Is Associated With More Complications and Emergency Department Visits but Equivalent 5-Year
Stephen M Gillinov1, David N Kim1, Wasif Islam1
1Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
Purpose:
To compare 90-day complications, 30-day emergency department (ED) visits, and 5-year rate of secondary surgeries for patients with Medicaid vs commercial insurance undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and/or labral tears using a large national database.
Methods:
The PearlDiver Mariner151 database was used to identify patients with International Classification of Diseases, Tenth Revision diagnosis codes for FAIS and/or labral tear who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021. Patients with Medicaid were matched 1:4 to a control group of commercially insured patients based on age, sex, body mass index, and Elixhauser Comorbidity Index. Rates of 90-day complications and 30-day ED visits were compared using multivariate regression models. Five-year rates of secondary surgeries-revision arthroscopy or total hip arthroplasty-were compared between cohorts by Kaplan-Meier analysis.
Results:
A total of 2,033 Medicaid patients were matched with 8,056 commercially insured patients. Rates of adverse events were low; however, Medicaid patients were significantly more likely than commercially insured patients to experience any 90-day complication (2.12% vs 1.43%; odds ratio [OR], 1.2; P = .02). Medicaid patients also experienced more 30-day ED visits than commercially insured patients (8.61% vs 4.28%), and on multivariate logistic regression, insurance status was the strongest determinant of 30-day ED visits (relative to commercial, Medicaid OR, 2.02; P < .001). Despite these differences, 5-year rates of secondary surgeries were comparable between groups (6.1% vs 6.0%; P = .6).
Conclusions:
In this large national database study, Medicaid patients undergoing primary hip arthroscopy showed significantly greater odds of experiencing 90-day postoperative complications and 30-day ED visits compared to commercially insured patients. Nevertheless, both groups had similar survivorship rates at 5-year follow-up, similar to prior estimates irrespective of insurance. These results document encouraging secondary surgery rates in Medicaid patients.
Insights
Patients with Medicaid undergoing hip arthroscopy had more short-term complications and emergency visits than commercially insured patients. However, long-term secondary surgery rates were similar, showing comparable outcomes for hip preservation surgery.
Area of Science:
- Orthopedic surgery
- Health services research
- Health economics
Background:
- Hip arthroscopy is a common procedure for femoroacetabular impingement syndrome (FAIS) and labral tears.
- Insurance status may influence patient outcomes and healthcare utilization.
- Understanding disparities in surgical outcomes is crucial for equitable healthcare delivery.
Purpose of the Study:
- To compare 90-day complications, 30-day emergency department (ED) visits, and 5-year secondary surgery rates.
- To evaluate outcomes for patients with Medicaid versus commercial insurance undergoing primary hip arthroscopy.
- To identify potential disparities in care for hip preservation surgery based on insurance type.
Main Methods:
- Utilized the PearlDiver Mariner database (2015-2021) for hip arthroscopy patients with FAIS and/or labral tears.
- Matched 2,033 Medicaid patients with 8,056 commercially insured patients 1:4 based on demographics and comorbidities.
- Compared 90-day complications and 30-day ED visits using multivariate regression; analyzed 5-year secondary surgery rates via Kaplan-Meier analysis.
Main Results:
- Medicaid patients had higher rates of 90-day complications (2.12% vs 1.43%) and 30-day ED visits (8.61% vs 4.28%) compared to commercially insured patients.
- Insurance status was the strongest predictor of 30-day ED visits (OR, 2.02 for Medicaid).
- Five-year rates of secondary surgeries (revision arthroscopy or hip replacement) were similar between groups (6.1% vs 6.0%).
Conclusions:
- Medicaid patients undergoing primary hip arthroscopy face higher risks of short-term postoperative complications and ED visits.
- Despite short-term disparities, long-term outcomes regarding secondary surgeries are comparable between Medicaid and commercially insured patients.
- These findings highlight the need to address access and follow-up care for Medicaid patients while affirming the effectiveness of hip preservation surgery across insurance types.
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