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Medicare Advantage Is Associated With Higher Mortality After Antibiotic Spacer Placement for Periprosthetic Joint
Nathanael D Heckmann1, Julian Wier1, Kevin C Liu1
1Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California.
Background:
Privatized Medicare Advantage (MA) plans are an alternative to traditional Medicare (TM). We sought to identify differences in 90-day postoperative mortality and nonfatal adverse events between TM and MA patients undergoing stage 1 antibiotic spacer placement for periprosthetic joint infection (PJI) of the hip or knee.
Methods:
A nationally representative database was queried from 2015 to 2021 for adult patients undergoing stage 1 antibiotic spacer placement for PJI. Using the International Classification of Disease, 10th Revision, and Current Procedural Terminology codes, as well as hospital charges for antibiotics, patients undergoing stage 1 exchange arthroplasty for PJI were identified. Patients were then grouped into TM and MA cohorts. The primary outcome was the odds of 90-day mortality. Multivariable logistic regressions were conducted to address possible confounding demographic, comorbidity, and hospital characteristics.
Results:
Of the 40,346 patients undergoing stage 1 spacer placement for PJI, 16,637 (41.2%) had TM coverage and 9,218 (22.8%) had MA coverage. Mortality within 90 days of surgery was higher in the MA cohort (1.4% versus 1.0%, P = 0.004). Multivariable logistic regression demonstrated significantly higher adjusted odds of mortality (adjusted odds ratio = 1.42, 95% confidence interval = 1.11 to 1.81, P = 0.005) in MA patients compared to TM.
Conclusions:
Even after accounting for available confounders with our multivariable analyses, patients enrolled in an MA plan were more than 40% more likely to die within 90 days of surgery compared to patients who have TM coverage. Further study is necessary to better understand the underlying cause of this finding.
Insights
Medicare Advantage (MA) patients undergoing hip or knee surgery for periprosthetic joint infection (PJI) had higher 90-day mortality compared to traditional Medicare (TM) patients. This study highlights potential disparities in outcomes for MA enrollees.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Public Health
Background:
- Medicare Advantage (MA) plans offer an alternative to traditional Medicare (TM).
- Periprosthetic joint infection (PJI) is a serious complication following hip or knee replacement surgery.
- Stage 1 antibiotic spacer placement is a critical intervention for managing PJI.
Purpose of the Study:
- To compare 90-day postoperative mortality and adverse events between TM and MA patients undergoing stage 1 antibiotic spacer placement for PJI.
- To identify potential disparities in surgical outcomes based on insurance type.
Main Methods:
- A retrospective analysis of a national database (2015-2021) identified adult patients undergoing stage 1 antibiotic spacer placement for PJI.
- Patients were stratified into TM and MA cohorts based on insurance coverage.
- Multivariable logistic regression analyses were performed to adjust for demographic, comorbidity, and hospital-related confounders.
Main Results:
- The study included 40,346 patients, with 16,637 (41.2%) in the TM cohort and 9,218 (22.8%) in the MA cohort.
- Ninety-day postoperative mortality was higher in the MA cohort (1.4%) compared to the TM cohort (1.0%) (P = 0.004).
- Adjusted analyses revealed significantly higher odds of mortality for MA patients (aOR = 1.42, 95% CI = 1.11-1.81, P = 0.005).
Conclusions:
- Patients enrolled in Medicare Advantage plans demonstrated a >40% increased likelihood of 90-day mortality following stage 1 PJI surgery compared to traditional Medicare beneficiaries.
- These findings persist even after controlling for known confounding factors.
- Further research is warranted to elucidate the specific reasons behind this observed outcome disparity.
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