Insurance status affects in-hospital complication rates after total knee arthroplasty

March 6, 2018, Boston University School of Medicine

In-hospital complications following total knee arthroplasty (TKA) are higher among Medicare and Medicaid patients compared to those with private insurance.

The study, which appears in the journal Orthopedics, is believed to the largest and most comprehensive assessment of medical and surgical com¬plications after TKA and of specifically how ' affects overall complication rates.

TKA is one of the most commonly per¬formed inpatient procedures in the United States. In 2010, 693,400 were performed in pa¬tients older than 45 years, and the demand is projected to rise dramatically during the next decade in response to the aging "baby boomer" population.

Using a large all-payer inpatient health care database, researchers from Boston University School of Medicine (BUSM) found cardiac events were the most common complication and occurred in eight percent of the Medicare patients, more than twice the rate of patients with pri-vate insurance. Urinary tract infections and surgery-related com¬plications were the next two most fre¬quent complications overall, and both were more commonly seen in those pa¬tients with government-sponsored insur¬ance (Medicaid/Medicare). Urinary tract infection was seen in three percent of Medicare patients and nearly three percent of Medicaid/uninsured patients, compared with 1.8 percent of the pri¬vately insured patients.

After controlling for age, sex and other demographic factors and comorbidi¬ties between Medicare and , patients with Medicare insurance had significantly higher risks of developing central nervous system com¬plications, gastrointestinal complications, wound breakdown and postoperative anemia and also had an increased rate of mortality compared with patients with pri¬vate insurance. There was no significant difference in both the medical compli-cations or mortality between publicly insured patients with Medicare versus Medicaid. These find¬ings are similar to those of previous stud¬ies that found increased complications in patients with Medicaid insurance after total knee replacement surgery compared to privately insured patients.

"Our study results indicate that patients with Medicare insurance have higher in-hospital complication rates after TKA compared to the privately insured patients with a matched cohort," said Xinning Li, MD, associate professor of orthopedic surgery at BUSM and an orthopedic surgeon specializing in sports medicine and shoulder surgery at Boston Medical Center. "As the landscape of healthcare changes with both reimbursements and bundle payments for joint arthroplasties, insurance status or patients with lower socioeconomic status should be factored into the final formula and risk adjusted for both physician and hospital reimbursement."

According to the researchers, the data suggest that insurance status may be considered as an independent risk factor for increased com¬plications when stratifying patients preop¬eratively for total knee replacement. "Fur¬ther research is needed to investigate the disparities in these findings to optimize patient outcomes following TKA."

Explore further: Insurance status impacts complication rates after shoulder replacement surgery

Related Stories

Insurance status impacts complication rates after shoulder replacement surgery

February 13, 2017
Patients undergoing shoulder replacement surgery who have Medicaid, Medicare or no health insurance, had higher complication rates as compared to patients who had private insurance.

Minimally invasive surgeries underused in older patients, new study finds

March 5, 2018
A study of more than 200,000 Medicare patients who had common surgical procedures shows that, compared to the general population, they underwent far fewer minimally invasive operations, whose benefits include lower rates ...

VA patients face disparities in kidney transplantation

November 5, 2017
Military veterans with VA insurance experience low rates of transplantation and high rates of death while on the transplant waiting list, according to a study that will be presented at ASN Kidney Week 2017 October 31-November ...

Medicaid patients at higher risk of complications after spine surgery

July 15, 2013
Among patients undergoing spinal surgery, Medicaid beneficiaries are at higher risk of experiencing any type of complication, compared to privately insured patients, reports a study in the July 15 issue of of Spine.

Differences in cancer survival by type of insurance

December 4, 2017
(HealthDay)—From 1997 to 2014, improvements in cancer survival were mainly limited to patients with private or Medicare insurance, according to a study published online Nov. 30 in JAMA Oncology.

Outcomes for cardiac valve procedure patients are affected by insurance status

July 6, 2011
The type of primary insurance patients carry affects outcomes of cardiac valve operations in the United States according to a study in the May issue of the Journal of the American College of Surgeons. As a result, the type ...

Recommended for you

Blood stored longer may be less safe for patients with massive blood loss and shock

March 10, 2018
Human blood from donors can be stored for use up to 42 days, and it is a mainstay therapy in transfusion medicine. However, recent studies looking back at patient records have shown that transfusion with older, stored blood ...

After knee replacement, play on

March 8, 2018
(HealthDay)—Knee replacement patients can continue to enjoy sports—such as skiing, tennis and dancing—without worrying that high-impact activities might compromise their new joint, a small, new study finds.

Engineered cartilage template to heal broken bones

March 8, 2018
A team of UConn Health researchers has designed a novel, hybrid hydrogel system to help address some of the challenges in repairing bone in the event of injury. The UConn Health team, led by associate professor of orthopedic ...

Treating hypothyroidism to stop a stubborn surgical complication

March 7, 2018
Researchers at the University of Michigan have discovered a link between low thyroid hormone levels and wound healing complications.

Neurocognitive impairment linked to worse outcomes after total joint replacement

March 6, 2018
People with undiagnosed neurocognitive deficits are undergoing hip and knee replacements at high rates and are more likely to have poorer short-term outcomes after surgery, according to new research led by orthopedic surgeons ...

Gastric bypass surgery can give better control for diabetes and obesity than lifestyle modification

March 2, 2018
Gastric bypass surgery can give better control for diabetes and obesity than lifestyle modificationIn a randomized clinical trial comparing two treatments, both groups of participants report significant weight loss, better ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.