Impact of Insurance Type on Timing of Diagnosis and Surgical Treatment of Acute Achilles Tendon Ruptures: A 2-Center Retrospective Cohort Study.

Introduction/PurposeDelayed treatment of acute Achilles tendon rupture is associated with worse outcomes and higher complication rates. Prior studies suggest reduced access to care among Medicaid and uninsured patients. This study examines the effect of insurance status on the timing of diagnosis and surgical treatment among patients undergoing surgical repair of acute Achilles tendon rupture.MethodsA retrospective chart review was conducted of patients aged ≥18 years with acute traumatic Achilles tendon ruptures identified by Current Procedural Terminology codes 27650 and 27654 at 2 hospitals between January 2017 and December 2023. Dates of injury, emergency department presentation, initial outpatient orthopaedic evaluation, and surgical intervention were recorded. Only patients who ultimately underwent operative repair were eligible for inclusion; because case ascertainment relied on surgical procedure codes, the cohort does not capture patients managed nonoperatively or those who never reached surgical care. Insurance status was categorized as private or Medicaid/uninsured. Postoperative complications, including re-rupture, infection, venous thromboembolism, wound dehiscence, return to the operating room, and mortality, were documented. Between-group comparisons of continuous variables were performed using the Mann-Whitney U test, given non-normal distribution of the underlying data; independent 2-tailed t-tests were performed as a secondary, confirmatory analysis. Significance was set at P < .05.ResultsThirty-eight surgically treated patients met the inclusion criteria, including 23 with private insurance and 15 who were Medicaid or uninsured. Median age was 35.2 years, and 89.5% were male. All time intervals are reported as medians. Time from injury to emergency department presentation was longer in the Medicaid/uninsured group but not statistically significant (1.0 vs 0.0 days; Mann-Whitney U P = .079). Medicaid/uninsured patients experienced significantly longer delays from injury to initial outpatient orthopaedic evaluation (17.0 vs 4.0 days; Mann-Whitney U P = .024) and from injury to surgery (30.0 vs 10.0 days; Mann-Whitney U P = .045). Time from orthopaedic evaluation to surgery did not differ significantly between groups (11.0 vs 6.0 days; Mann-Whitney U P = .206). Postoperative complications were infrequent in both groups; the study was not powered for comparison of complication rates and none was performed.ConclusionAmong surgically treated patients, those with Medicaid or no insurance experienced significantly longer delays to initial orthopaedic evaluation and to surgical repair compared with privately insured patients, highlighting disparities in access to timely orthopaedic care within this surgically treated population.Level of Evidence:III.