Payor Type Is Associated with Increased Rates of Reoperation and Healthcare Utilization following Rotator Cuff Repair: A National Database Study.

Abstract

Despite strong evidence supporting the efficacy of rotator cuff repair (RCR), previous literature has demonstrated that socioeconomic disparities exist among patients who undergo surgery. There is a paucity of literature examining whether payor type, including Medicare, Medicaid, and commercial insurance types, impacts early medical complications and rates of reoperation following RCR. Patients with Medicare, Medicaid, or commercial payor type insurance who underwent primary open or arthroscopic RCR between 2010 and 2019 were identified using a large national database. Ninety-day incidence of medical complications, emergency department (ED) visit, and hospital readmission, as well as one-year incidence of revision repair, revision to arthroplasty, and cost of care were evaluated. Propensity score matching was used to control for patient demographic factors and comorbidities as covariates. 113,257 Medicare, 23,074 Medicaid, and 414,447 commercially insured patients were included for analysis. Medicaid insurance was associated with an increased 90-day risk of various medical complications, ED visit (OR 2.87; p<0.001) and one-year revision RCR (OR 1.60; p<0.001) compared to Medicare insurance. Medicaid insurance was also associated with an increased risk of various medical complications, ED visit (OR 2.98; p<0.001), hospital readmission (OR 1.56; p=0.002), as well as one-year risk of revision RCR (OR 1.60; p<0.001) and conversion to arthroplasty (OR 1.4358; p<0.001) compared to commercially insured patients. Medicaid insurance was associated with a decreased risk of conversion to arthroplasty compared to Medicare patients (OR 0.6887; p<0.001). Medicaid insurance was associated with higher one year cost of care compared to patients with both Medicare (p<0.001) and commercial insurance (p<0.001). Medicaid insurance is associated with increased rates of medical complications, healthcare utilization, and reoperation following rotator cuff surgery, despite controlling for covariates. Medicaid insurance is also associated with a higher one-year cost of care. Understanding the complex relationship between sociodemographic factors, such as insurance status, medical comorbidities, and outcomes, is necessary to ensure optimal healthcare access for all patients and to allow for appropriate risk stratification.