Insurance Payer type and Income are associated with outcomes after total shoulder arthroplasty Insurance payer, Income and Shoulder Arthr
Jasvinder A. Singh, MBBS, MPH1,2,3 and John D. Cleveland, MS2Shoulder
Objective:
To assess the independent association of insurance and income with total shoulder arthroplasty (TSA) outcomes.
Methods:
We used the 1998-2014 U.S. National Inpatient Sample. We used multivariable-adjusted logistic regression to examine whether insurance type and median household income (based on zip code) were independently associated with healthcare utilization (discharge destination, hospital stay duration, total hospital charges) and in-hospital complications post-TSA based on the diagnostic codes (fracture, infection, transfusion or revision surgery). We calculated the odds ratio (OR) and 95% confidence intervals (CI).
Results:
Among the 349,046 projected TSA hospitalizations, the mean age was 68.3 years, 54% were female, 73% White. Compared to private insurance, Medicaid and Medicare payers were associated with significantly higher adjusted OR (95% CI) of: (1) discharge to a rehabilitation facility, 2.16 (1.72,2.70) and 2.27 (2.04,2.52); (2) hospital stay >2 days, 1.65 (1.45,1.87) and 1.60 (1.52,1.69); and (3) transfusion, 1.35 (1.05,1.75) and 1.39 (1.24,1.56), respectively. Medicaid was associated with a higher risk of fracture, 1.74 (1.07,2.84) and Medicare payer with a higher risk of infection, 2.63 (1.24,5.57); neither were associated with revision. Compared to the highest income quartile, the lowest income quartile was significantly associated with (OR (95% CI)): (1) discharge to a rehabilitation facility, 0.89 (0.83,0.96); (2) hospital stay >2 days, 0.84 (0.80,0.89); (3) hospital charges above the median, 1.19 (1.14,1.25); (4) transfusion, 0.73 (0.66,0.81); and (5) revision, 0.49 (0.30,0.80), but not infection or fracture.
Conclusion:
This information can help to risk-stratify patients post-TSA. Future assessments of modifiable mediators of these complications are needed.
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