Medicare and Medicaid patients undergoing total joint arthroplasty have more complications and healthcare utilization than privately insured patients.

AIMS &

OBJECTIVES

This study characterized the independent association between insurance type and healthcare outcomes in patients undergoing total joint arthroplasty (TJA).

MATERIALS &

METHODS

National data identified patients who underwent total hip, knee, shoulder, elbow, ankle or wrist joint arthroplasty surgery from 2012 to 2020 for osteoarthritis. Medicaid, Medicare≥65 years old, Medicare<65 years old, and uninsured patients were matched to privately insured patients based on age, sex, and comorbidities. Multivariable analysis, controlled for various characteristics, was conducted to quantify various outcome measures by payer status.

RESULTS

Medicaid patients had greater odds of cardiac, genitourinary, hematoma/hemorrhage/seroma, respiratory, and wound dehiscence complications than privately insured (odds ratio [OR]: 1.5, 1.2, 1.6, 1.3, 1.5, respectively; p < 0.01). Medicare patients ≥65 years old had greater odds of cardiac and wound dehiscence complications but fewer central nervous system and genitourinary complications and post-operative infections than privately insured (OR:1.2, 1.2, 0.3, 0.8, 0.7, respectively; p < 0.01). Medicare<65 years old patients had greater odds of cardiac, gastrointestinal, genitourinary, hematoma/hemorrhage/seroma, post-operative anemia, respiratory, and wound dehiscence complications than privately insured (OR: 1.2, 1.4, 1.2, 1.4, 1.2, 1.7, 1.6, respectively; p < 0.01). Medicare≥65, Medicare<65, and Medicaid patients had $2,243, $3,849, and $1170 more total charges, respectively (p < 0.01).

CONCLUSION

Despite Medicaid expansion through the 2014 Affordable Care Act, marked disparities in complications after TJA between individuals with and without private insurance still exist. Medicare<65 and Medicaid cohorts demonstrated higher complication rates than private payers, possibly attributable to barriers in healthcare such as patient education, access to healthcare, and social determinants of health.