Disparities in operative fixation for acromioclavicular joint injuries: an analysis of insurance status

Acromioclavicular (AC) joint injury management has historically been guided by the severity and grade of the injury. However, recent debates have emerged regarding the role of surgical intervention for these injuries. Insurance-based disparities in surgical treatment have been well-documented across various orthopedic conditions. This study seeks to determine whether insurance coverage influences the likelihood of undergoing surgical fixation for AC joint dislocation.

We conducted a retrospective analysis of the National Readmissions Database spanning from 2016 to 2021. Using International Classification of Diseases, 10th Revision codes, we identified patients with isolated AC joint dislocation and determined whether they received surgical intervention based on International Classification of Diseases, 10th Revision procedural codes. A total of 5654 cases of AC joint dislocation were identified, of which 219 (3.9%) underwent operative management. Statistical analysis was conducted via univariate analysis using Pearson's chi-square test, followed by multivariable logistic regression to assess the significance of demographic and socioeconomic factors on likelihood of operative intervention. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).

After adjusting for demographic and socioeconomic variables including age, sex, income quartile, and medical comorbidities, patients with Medicaid insurance were significantly less likely to receive surgical intervention for AC joint dislocation compared to those with private insurance (OR 0.51; 95% CI 0.34-0.76; P < .01). Furthermore, individuals residing in areas with the highest income quartile by ZIP code exhibited the greatest likelihood of undergoing surgery (OR 1.91; 95% CI 1.27-2.89; P < .01), in contrast to those in lower income areas.

This study suggests that patients insured by Medicaid are less likely to undergo surgery for AC joint injury compared to those with private insurance. Additionally, patients from higher income areas were more likely to receive operative treatment. These findings emphasize the need for more standardized treatment guidelines, particularly as the controversy surrounding operative vs. nonoperative management of these injuries persists, and no definitive gold standard surgical technique exists. Surgeons must remain vigilant of these biases that may influence clinical decision-making.