Profound Impact of Insurance Payor and Socioeconomic Status in Total Hip Arthroplasty Outcomes: Results From a High Volume Tertiary Care Center

Joseph, Koressel; Perez, Brian A.; D, DeAngelis Ryan; Yehuda, Kerbel; P, Sheth Neil; L, Nelson Charles

doi:10.1016/j.arth.2022.03.018

Cited by 6 publications

(4 citation statements)

References 19 publications

(21 reference statements)

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“…Our key independent variable was the patient's socioeconomic status as measured by a categorical indicator of the payor for the outpatient visit (Private, Medicare, Medicaid, Workers' Compensation, other). Payor type has been utilized as a surrogate for socioeconomic status in multiple studies due to its consistent documentation in the electronic medical record system as a result of its link to billing [12][13][14]. Medicaid is a needs-based insurance that is based on state and federal guidelines regarding poverty indices [15].…”

Section: Key Independent Variablesmentioning

confidence: 99%

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Lawlor,

Rubery,

Thirukumaran

et al. 2024

Cureus

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Objective To explore how socioeconomic status and patient characteristics may be associated with initial self-reports of pain and determine if there was an increased association with undergoing spine surgery. Methods Patients at an academic center between 2015 and 2021 who completed the Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) questionnaire were included. Multivariable linear regression models were used to determine the association between insurance type and patient factors with initial reports of pain. Multivariable logistic regression models were used to determine the association between PI and the likelihood of surgery in two time periods, three and 12 months. Results The study included 9,587 patients. The mean PROMIS-PI scores were 61.93 (SD 7.82) and 63.74 (SD 6.93) in the cervical and lumbar cohorts, respectively. Medicaid and Workers’ Compensation insurance patients reported higher pain scores compared to those with private insurance: Medicaid (cervical: 2.77, CI (1.76-3.79), p<0.001; lumbar (2.05, CI (1.52-2.59), p<0.001); Workers’ Compensation (cervical: 2.12, CI (0.96-3.27), p<0.001; lumbar: 1.51, CI (0.79-2.23), p<0.001). Black patients reported higher pain compared to White patients (cervical: 1.50, CI (0.44-2.55), p=0.01; lumbar: 1.51, CI (0.94-2.08), p<0.001). Higher PROMIS-PI scores were associated with a higher likelihood of surgery. There was no increased association of likelihood of surgery in Black, Medicaid, or Workers’ Compensation patients when controlling for pain severity. Conclusion Black patients and patients with Medicaid and Workers’ compensation insurance were likely to report higher pain scores. Higher initial pain scores were associated with an increased likelihood of surgery. However, despite increased pain scores, Black patients and those with Medicaid and Workers’ Compensation insurance did not have a higher likelihood of undergoing surgery.

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Section: Key Independent Variablesmentioning

confidence: 99%

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Lawlor,

Rubery,

Thirukumaran

et al. 2024

Cureus

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“…Total hip arthroplasty (THA) is the standard treatment for end-stage ANFH and significantly improves hip function and quality of life (QoL) in rheumatic diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), although its complications and long-term survival are controversial [ 4 – 7 ]. There is a lack of studies on the clinical outcomes of THA in patients with PSS.…”

Section: Introductionmentioning

confidence: 99%

Primary Sjögren’s syndrome is not associated with poor outcomes after total hip arthroplasty: a retrospective case–control study with a matched cohort of osteoarthritis patients

Yang

et al. 2022

Clin Rheumatol

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Introduction The number of patients with primary Sjögren’s syndrome (PSS) requiring total hip arthroplasty (THA) is expected to increase, but few studies have detailed their outcomes. The purpose of this study was to evaluate a THA cohort of patients with avascular necrosis of the femoral head (ANFH) who had PSS and to compare their outcomes with those of matched patients with osteoarthritis. Method A case–control study using data from a single-institution arthroplasty registry was performed. Forty-two THAs in 32 patients undergoing THA with a diagnosis of PSS were identified and were matched with 84 THAs in 64 patients with osteoarthritis (1:2 ratio). Functional and health-related quality of life (QoL) evaluations were performed, and complications were recorded at the last follow-up. Logistic regression was used to determine factors associated with reaching the transfusion trigger of hemoglobin < 8 g/dL (TT8) in PSS patients. Results After a mean 5-year follow-up, both cohorts had similar hip function and health-related QoL outcomes. The incision complications and reaching TT8 were greater in the PSS group. No differences were observed in the rate of 90-day readmission, reoperation, or overall revision. By multivariate analysis, the influencing factors for reaching TT8 in PSS patients were lower preoperative hemoglobin ( OR = 0.842, 95% CI [0.741–0.958], P < 0.05). Conclusion Our study demonstrated PSS patients who received THA due to ANFH could achieve clinical outcomes similar to those of non-PSS patients. Improving preoperative Hb level can reduce the risk of transfusion. Key Points • THA significantly improved hip function and health-related quality of life in PSS patients with osteonecrosis of the femoral head. • Patients with PSS were more likely to reach the transfusion trigger and higher rates of incision complications after THA. • Improving preoperative Hb level can reduce the risk of transfusion for PSS patients who underwent THA. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-022-06256-2.

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“… 18 , 19 Furthermore, Koressel et al. 20 found that outcomes of patients undergoing total hip arthroplasty were poorer for those eligible for both Medicare and Medicaid than for those with other insurance plans. Various studies have been conducted on the impact of socioeconomic factors on the utilization and outcomes of total hip arthroplasty.…”

mentioning

confidence: 99%

Income and Insurance Status Impact Access to Health Care for Hip Osteoarthritis

Youn

Shin²,

Haratian

et al. 2023

Arthroscopy, Sports Medicine, and Rehabilitation

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Profound Impact of Insurance Payor and Socioeconomic Status in Total Hip Arthroplasty Outcomes: Results From a High Volume Tertiary Care Center

Cited by 6 publications

References 19 publications

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Primary Sjögren’s syndrome is not associated with poor outcomes after total hip arthroplasty: a retrospective case–control study with a matched cohort of osteoarthritis patients

Income and Insurance Status Impact Access to Health Care for Hip Osteoarthritis

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