Medicaid patients likely to undergo TJA by low-volume surgeons at low-volume hospitals

ByMax R. Wursta

Fact checked byGina Brockenbrough, MA

LAS VEGAS — According to presented results, Medicaid patients were more likely to undergo total joint arthroplasty by a low-volume surgeon at a low-volume hospital and have higher postoperative complications rates vs. non-Medicaid patients.

“Medicaid insurance type is associated with worse postoperative outcomes following total knee and total hip arthroplasty,” Mary K. Richardson, BS, a research fellow at the University of Southern California’s Keck School of Medicine, said in her presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “Independently, the literature has also shown us that lower-volume surgeons and lower-volume hospitals have also been associated with worse postoperative outcomes,” she added.

Hospital corridor — Medicaid patients were more likely to undergo TJA by a low-volume surgeon at a low-volume hospital. *Image: Adobe Stock*

Richardson and colleagues analyzed data from 1,204,624 patients who underwent total hip arthroplasty or total knee arthroplasty from 2015 to 2020. Among the cohort, 4.57% of patients (n = 55,021) were covered by Medicaid insurance. Researchers compared patient demographics, comorbidities, surgeon volume, hospital volume and 90-day complication rates in Medicaid vs. non-Medicaid patients.

Overall, Richardson and colleagues found 49.4% of Medicaid patients and 37.3% of non-Medicaid patients were treated by surgeons who performed less than 100 cases of THA or TKA per year. They also found 51.9% of Medicaid patients and 37.4% of non-Medicaid patients underwent their procedure at a hospital that had less than 500 cases of THA or TKA per year. Multivariate analysis showed Medicaid patients were at increased risk for deep venous thrombosis, pulmonary embolism, periprosthetic joint infection and readmission.

“Hospital systems can consider doing targeted interventions in this specific population to help reduce disparities in access to care,” Richardson said. “Policymakers can start to consider utilizing risk-adjusted payment strategies for this high-risk cohort,” she concluded.

Published by:

Sources/Disclosures

Collapse

Source:

Richardson MK, et al. Paper 138. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.

Disclosures: Richardson reports no relevant financial disclosures.

American Academy of Orthopaedic Surgeons Annual Meeting

Read more

Medicaid patients likely to undergo TJA by low-volume surgeons at low-volume hospitals

Related Content