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Medicaid Insurance Is Associated With Increased Readmissions and Mortality After Surgery for Periprosthetic Joint
Mary K Richardson1, Julian Wier, Dara Bruce
1From the Keck Medical Center of the University of Southern California, Los Angeles, CA (Richardson, Wier, Bruce, Liu, Lieberman, and Heckmann), and the Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA (Cohen-Rosenblum).
Background:
Patients with Medicaid insurance are at an increased risk of postoperative complications following total knee arthroplasty and total hip arthroplasty (TJA); however, their outcomes following revision TJA for periprosthetic joint infection (PJI) requires further study.
Methods:
A retrospective query was conducted for adult patients undergoing implant explantation and antibiotic spacer placement for TJA PJI from the Premier Healthcare Database between December 1, 2016, and December 31, 2021. Patients were then grouped by Medicaid or non-Medicaid insurance status and were age matched through exact caliper matching. Multivariable regression models addressed potential confounding. Adjusted risks of 90-day postoperative complications were reported.
Results:
Of the 40,346 patients identified, 2,711 Medicaid patients were matched to 10,844 non-Medicaid patients on age (56.1 vs. 56.1 years, P = 1.000). Patients with Medicaid experienced higher risk of sepsis (adjusted odds ratio [aOR] = 1.20, P = 0.010), readmission (aOR = 1.12, P = 0.022), being discharged to a skilled nursing facility (aOR = 1.13, P = 0.031), and had longer length of stay (9.48 vs. 6.67 days, P < 0.001), compared with patients with non-Medicaid. Medicaid patients had a higher rate of inpatient mortality (0.81% vs. 0.48%, P = 0.038); however, the risk was similar after accounting for differences in comorbidities.
Conclusion:
Following revision TJA for PJI, patients with Medicaid were at an increased risk for postoperative complication, including sepsis and readmission. They experienced a higher rate of inpatient mortality that may be driven by differences in comorbidities. Insurers and policy makers should consider this information to develop risk stratification-based payment strategies that take into account the healthcare burden of this high-risk patient population.
Level Of Evidence:
IV.
Insights
Patients with Medicaid insurance face higher risks of sepsis and readmission after revision total joint arthroplasty for periprosthetic joint infection. These findings highlight disparities in care for this patient group.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Public Health
Background:
- Patients with Medicaid insurance have higher complication risks after primary total knee arthroplasty and total hip arthroplasty.
- Outcomes for Medicaid patients undergoing revision total joint arthroplasty for periprosthetic joint infection are not well-established.
Purpose of the Study:
- To compare 90-day postoperative complication risks for patients with Medicaid versus non-Medicaid insurance undergoing revision total joint arthroplasty for periprosthetic joint infection.
- To identify specific complications and healthcare utilization patterns associated with insurance status in this patient population.
Main Methods:
- Retrospective analysis of adult patients undergoing implant explantation and antibiotic spacer placement for periprosthetic joint infection from December 2016 to December 2021.
- Age-matched cohort comparison between Medicaid and non-Medicaid patients using exact caliper matching.
- Multivariable regression models to adjust for potential confounding factors and report adjusted risks of 90-day postoperative complications.
Main Results:
- Medicaid patients (n=2,711) matched with non-Medicaid patients (n=10,844) showed increased risks of sepsis (aOR=1.20), readmission (aOR=1.12), and discharge to skilled nursing facilities (aOR=1.13).
- Medicaid patients experienced longer hospital stays (9.48 vs. 6.67 days) and a higher rate of inpatient mortality (0.81% vs. 0.48%).
- The increased inpatient mortality risk for Medicaid patients was comparable after accounting for comorbidities.
Conclusions:
- Revision total joint arthroplasty for periprosthetic joint infection is associated with increased postoperative complications, including sepsis and readmission, for patients with Medicaid insurance.
- Higher inpatient mortality in Medicaid patients may be linked to underlying comorbidity differences.
- Insurers and policymakers should consider risk stratification-based payment models to address the healthcare burden of this high-risk population.
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