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The Journal of Hip Surgery 2024; 08(03): 141-148
DOI: 10.1055/s-0044-1781434
Original Article

Insurance Status Predicts Periprosthetic Joint Infection after Total Hip Arthroplasty

Jeremiah Thomas
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Utkarsh Anil 
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Thomas Schmicker
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Charles C. Lin
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Vinay K. Aggarwal 
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Ran Schwarzkopf
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Abstract

Periprosthetic joint infection (PJI) is one of the most severe complications following total hip arthroplasty (THA), and identifying factors associated with PJI is vital for preoperative risk stratification. The aim of this study was to compare risk of PJI after THA across insurance payers using a statewide health data registry. A retrospective review was conducted querying the New York Statewide Planning and Research Cooperative System for all patients undergoing elective unilateral primary THA using International Classification of Diseases (ICD)-9 and ICD-10 procedure codes. Patients were stratified into groups based on their insurance provider as private payer, Medicare, Medicaid, or worker's compensation. Demographics, hospital clinical data, complications, PJI rates, and mortality rates were collected. PJI rates were significantly different between groups at both 3 (p < 0.001) and 12 months (p < 0.001) postoperatively, highest at both time points in the Medicaid group (3 months: 1.3%; 12 months: 1.8%). Log-rank test demonstrated increased cumulative PJI rates in the worker's compensation and Medicaid groups up to 108 months postoperatively (p < 0.001). Multivariate Cox proportional hazard regression, adjusted for demographics, found that Medicaid insurance was associated with 1.4 times increased risk for PJI relative to Medicare (hazard ratio:1.39; 95% confidence interval [1.19, 1.62]; p < 0.001). These results suggest patients undergoing THA covered by Medicaid are at increased risk for PJI compared with patients covered by other insurance payers. Surgeons should recognize this patient population is at an increased risk for PJI, and compensation policies for treating patients covered by Medicaid should reflect the increased complication rate associated with this population.

Keywords

insurance - periprosthetic joint infection - total hip arthroplasty - Medicaid


Publikationsverlauf

Eingereicht: 29. November 2022

Angenommen: 17. Januar 2024

Artikel online veröffentlicht:
05. März 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 2005; 87 (08) 1746-1751
    PubMedSuche in Google Scholar
  • 2 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
    CrossrefPubMedSuche in Google Scholar
  • 3 Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev 2014; 27 (02) 302-345
    CrossrefPubMedSuche in Google Scholar
  • 4 Gundtoft PH, Pedersen AB, Varnum C, Overgaard S. Increased mortality after prosthetic joint infection in primary THA. Clin Orthop Relat Res 2017; 475 (11) 2623-2631
    CrossrefPubMedSuche in Google Scholar
  • 5 Wildeman P, Rolfson O, Söderquist B, Wretenberg P, Lindgren V. What are the long-term outcomes of mortality, quality of life, and hip function after prosthetic joint infection of the hip? A 10-year follow-up from Sweden. Clin Orthop Relat Res 2021; 479 (10) 2203-2213
    CrossrefPubMedSuche in Google Scholar
  • 6 Schwartz AM, Farley KX, Guild GN, Bradbury Jr TL. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty 2020; 35 (6S): S79-S85
    CrossrefPubMedSuche in Google Scholar
  • 7 Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 2014; 29 (05) 929-932
    CrossrefPubMedSuche in Google Scholar
  • 8 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedSuche in Google Scholar
  • 9 Chisari E, Yayac M, Sherman M, Kozaily E, Courtney PM. Which socioeconomic factors affect outcomes following total hip and knee arthroplasty?. J Arthroplasty 2021; 36 (06) 1873-1878
    CrossrefPubMedSuche in Google Scholar
  • 10 Sniderman J, Stark RB, Schwartz CE, Imam H, Finkelstein JA, Nousiainen MT. Patient factors that matter in predicting hip arthroplasty outcomes: a machine-learning approach. J Arthroplasty 2021; 36 (06) 2024-2032
    CrossrefPubMedSuche in Google Scholar
  • 11 Kawai T, Kataoka M, Goto K, Kuroda Y, So K, Matsuda S. Patient- and surgery-related factors that affect patient-reported outcomes after total hip arthroplasty. J Clin Med 2018; 7 (10) 358
    CrossrefPubMedSuche in Google Scholar
  • 12 Aggarwal A, Naylor JM, Adie S, Liu VK, Harris IA. Preoperative factors and patient-reported outcomes after total hip arthroplasty: multivariable prediction modeling. J Arthroplasty 2022; 37 (04) 714-720.e4
    CrossrefPubMedSuche in Google Scholar
  • 13 Veltre DR, Sing DC, Yi PH. et al. Insurance status affects complication rates after total hip arthroplasty. J Am Acad Orthop Surg 2019; 27 (13) e606-e611
    CrossrefPubMedSuche in Google Scholar
  • 14 Xu HF, White RS, Sastow DL, Andreae MH, Gaber-Baylis LK, Turnbull ZA. Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York. J Clin Anesth 2017; 43: 24-32
    CrossrefPubMedSuche in Google Scholar
  • 15 Hinman A, Bozic KJ. Impact of payer type on resource utilization, outcomes and access to care in total hip arthroplasty. J Arthroplasty 2008; 23 (6, Suppl 1): 9-14
    CrossrefPubMedSuche in Google Scholar
  • 16 Halawi MJ, Cote MP, Savoy L, Williams VJ, Lieberman JR. The effect of payer type on patient-reported outcomes in total joint arthroplasty is modulated by baseline patient characteristics. J Arthroplasty 2019; 34 (06) 1072-1075
    CrossrefPubMedSuche in Google Scholar
  • 17 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
    CrossrefPubMedSuche in Google Scholar
  • 18 DeKeyser GJ, Anderson MB, Meeks HD, Pelt CE, Peters CL, Gililland JM. Socioeconomic status may not be a risk factor for periprosthetic joint infection. J Arthroplasty 2020; 35 (07) 1900-1905
    CrossrefPubMedSuche in Google Scholar
  • 19 D'Apuzzo MR, Villa JM, Alcerro JC, Rossi MD, Lavernia CJ. Total Joint arthroplasty: a granular analysis of outcomes in the economically disadvantaged patient. J Arthroplasty 2016; 31 (9, Suppl): 41-44
    CrossrefPubMedSuche in Google Scholar
  • 20 Shau D, Shenvi N, Easley K, Smith M, Bradbury T, Guild III G. Medicaid payer status is associated with increased 90-day morbidity and resource utilization following primary total hip arthroplasty: a propensity-score-matched analysis. J Bone Joint Surg Am 2018; 100 (23) 2041-2049
    CrossrefPubMedSuche in Google Scholar
  • 21 Browne JA, Novicoff WM, D'Apuzzo MR. Medicaid payer status is associated with in-hospital morbidity and resource utilization following primary total joint arthroplasty. J Bone Joint Surg Am 2014; 96 (21) e180
    CrossrefPubMedSuche in Google Scholar
  • 22 Maman SR, Andreae MH, Gaber-Baylis LK, Turnbull ZA, White RS. Medicaid insurance status predicts postoperative mortality after total knee arthroplasty in state inpatient databases. J Comp Eff Res 2019; 8 (14) 1213-1228
    CrossrefPubMedSuche in Google Scholar
  • 23 Veltre DR, Yi PH, Sing DC. et al. Insurance status affects in-hospital complication rates after total knee arthroplasty. Orthopedics 2018; 41 (03) e340-e347
    CrossrefPubMedSuche in Google Scholar
  • 24 Roof MA, Feng JE, Anoushiravani AA. et al. The effect of patient point of entry and Medicaid status on quality outcomes following total hip arthroplasty. Bone Joint J 2020; 102-B (7_Suppl_B): 78-84
    CrossrefPubMedSuche in Google Scholar
  • 25 Gonzalez AI, Luime JJ, Uçkay I, Hannouche D, Hoffmeyer P, Lübbeke A. Is there an association between smoking status and prosthetic joint infection after primary total joint arthroplasty?. J Arthroplasty 2018; 33 (07) 2218-2224
    CrossrefPubMedSuche in Google Scholar
  • 26 Ren X, Ling L, Qi L. et al. Patients' risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies. BMC Musculoskelet Disord 2021; 22 (01) 776
    CrossrefPubMedSuche in Google Scholar
  • 27 Lenguerrand E, Whitehouse MR, Beswick AD. et al. Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. Lancet Infect Dis 2018; 18 (09) 1004-1014
    CrossrefPubMedSuche in Google Scholar
  • 28 Greene BD, Lange JK, Heng M, Melnic CM, Smith JT. Correlation between patient-reported outcome measures and health insurance provider types in patients with hip osteoarthritis. J Bone Joint Surg Am 2021; 103 (16) 1521-1530
    CrossrefPubMedSuche in Google Scholar
  • 29 Cheng H, Chen BPH, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect (Larchmt) 2017; 18 (06) 722-735
    CrossrefPubMedSuche in Google Scholar
  • 30 Warth LC, Callaghan JJ, Wells CW. et al. Demographic and comorbid disparities based on payer type in a total joint arthroplasty cohort: implications in a changing health care arena. Iowa Orthop J 2011; 31: 64-68
    PubMedSuche in Google Scholar
  • 31 Dy CJ, Salter A, Barker A, Brown D, Keller M, Olsen MA. Increased utilization of total joint arthroplasty after Medicaid expansion. J Bone Joint Surg Am 2021; 103 (06) 524-531
    CrossrefPubMedSuche in Google Scholar
  • 32 Slover JD. You want a successful bundle: what about post-discharge care?. J Arthroplasty 2016; 31 (05) 936-937
    CrossrefPubMedSuche in Google Scholar
  • 33 Cvetanovich GL, Savin DD, Frank RM. et al. Inferior outcomes and higher complication rates after shoulder arthroplasty in workers' compensation patients. J Shoulder Elbow Surg 2019; 28 (05) 875-881
    CrossrefPubMedSuche in Google Scholar
  • 34 Russo F, De Salvatore S, Ambrosio L. et al. Does workers' compensation status affect outcomes after lumbar spine surgery? a systematic review and meta-analysis. Int J Environ Res Public Health 2021; 18 (11) 6165
    CrossrefPubMedSuche in Google Scholar
  • 35 Henn III RF, Tashjian RZ, Kang L, Green A. Patients with workers' compensation claims have worse outcomes after rotator cuff repair. J Bone Joint Surg Am 2008; 90 (10) 2105-2113
    CrossrefPubMedSuche in Google Scholar
  • 36 Mont MA, Mayerson JA, Krackow KA, Hungerford DS. Total knee arthroplasty in patients receiving workers' compensation. J Bone Joint Surg Am 1998; 80 (09) 1285-1290
    CrossrefPubMedSuche in Google Scholar
  • 37 Bojan B, Perni S, Prokopovich P. Systematic review and meta-analysis of tobacco use as a risk factor for prosthetic joint infection after total hip replacement. Arthroplast Today 2020; 6 (04) 959-971
    CrossrefPubMedSuche in Google Scholar
  • 38 Oronce CIA, Shao H, Shi L. Disparities in 30-day readmissions after total hip arthroplasty. Med Care 2015; 53 (11) 924-930
    CrossrefPubMedSuche in Google Scholar
  • 39 Singh JA, Cleveland JD. Medicaid or Medicare insurance payer status and household income are associated with outcomes after primary total hip arthroplasty. Clin Rheumatol 2018; 37 (09) 2489-2496
    CrossrefPubMedSuche in Google Scholar
  • 40 Doro C, Dimick J, Wainess R, Upchurch G, Urquhart A. Hospital volume and inpatient mortality outcomes of total hip arthroplasty in the United States. J Arthroplasty 2006; 21 (6, Suppl 2): 10-16
    CrossrefPubMedSuche in Google Scholar