Medicaid Payer Status, Higher Comorbidity, and Low Income Are Associated With Poorer Outcomes After Total Elbow Arthroplasty.

Abstract

To assess whether insurance payer, comorbidity, and income are associated with total elbow arthroplasty (TEA) outcomes. We used the 1998-2014 US National Inpatient Sample. Multivariable logistic regression adjusted for demographics and underlying diagnosis to estimate odds ratio (OR) and 95% confidence intervals (CI) of insurance payer, comorbidity, and income with TEA outcomes. The mean age was 60 (SE, 0.29) years, 68% were female, and 62% were white among the 7992 TEA procedures. Compared with private insurance, Medicaid was associated with significantly higher ORs (95% CI) of (1) hospital charges above the median, 1.25 (95% CI, 1.01-1.53); (2) discharge to a rehabilitation facility, 1.64 (95% CI, 1.16-2.31); (3) hospital stay >2 days, 1.63 (95% CI, 1.32-2.00); (4) fracture, 1.71 (95% CI, 1.14-2.56). Medicare payer was associated with higher ORs (95% CI) of (1) discharge to a rehabilitation facility, 1.80 (95% CI, 1.42-2.28); and (2) hospital stay >2 days, 1.29 (95% CI, 1.12-1.50). Compared with Deyo-Charlson score of zero, odds of health care utilization outcomes were higher by 14% to 20% for score of 1 and by 62% to 146% for score of 2 or higher, and by 36% to 257% for transfusion. The lowest income quartile had significantly higher OR of 1.51 (95% CI, 1.31-1.73) of hospital charges above the median versus the highest quartile. Payer type, comorbidity, and income were associated with higher health care utilization and complications post-TEA. Further investigation into potentially modifiable mediators is needed.