Associated Risk of Medicaid and Medicare Payer Status on Outcomes Following Total Joint Arthroplasty: A 10-Year...

This study examined the association between insurance type (Medicaid, Medicare, and private) and 90-day complications and patient-reported outcomes (PROs) following primary total joint arthroplasty (TJA).

Data from a single health system comprised of six hospitals was queried to include patients who underwent TJA from 2013 to 2023. The cohort consisted of 65,300 TJA cases (49,936 patients), with 52.6% privately insured, 42.64% Medicare, and 4.77% Medicaid. Medicaid patients were younger, with higher body mass index, smoking rates, and preoperative opioid usage (P < 0.001). Patients were categorized by insurance type and demographic information, comorbidities, 90-day outcomes, complications, and PROs were analyzed.

Medicaid patients had 81.7% higher emergency department visit odds than those privately insured and 63.6% more than Medicare (P < 0.0001). Medicaid payer status was associated with 63.3% increased odds of developing deep vein thrombosis compared to private insurance (P = 0.0119). Medicaid and Medicare patients faced 24.3 and 31.1% greater readmission odds than privately insured (P < 0.0001), respectively. Medicare patients had higher odds of urinary tract infections, periprosthetic joint infections, dislocation, and fracture (P < 0.0001). Conversely, private-payer patients were less likely to take preoperative medications and had fewer 90-day postoperative complications (P < 0.0001). Medicaid patients reported the lowest preoperative and postoperative Patient Reported Outcomes Measurement Information System Mental and Physical scores, Knee Injury and Osteoarthritis Outcome Score, and Hip Injury and Osteoarthritis Outcome Score, although they exhibited the greatest improvement in Knee Injury and Osteoarthritis Outcome Score and Hip Injury and Osteoarthritis Outcome Score scores after surgery.

Insurance payer type is significantly associated with postoperative outcomes, with Medicaid and Medicare patients experiencing higher complication rates and lower PROs than their privately insured counterparts. These disparities underscore the necessity for tailored preoperative and postoperative management in TJA patients based on insurance status.