Insurance Status Affects In-Hospital Complication Rates after TKA

    In-hospital complications following total knee arthroplasty (TKA) are higher among Medicare and Medicaid patients than among patients with private insurance, according to a recent study from Boston University School of Medicine (BUSM).

    The study, published in the journal Orthopedics, is believed to the largest and most comprehensive assessment of medical and surgical complications after TKA, specifically focused on how patients’ insurance status affects overall complication rates.

    Using a large all-payer inpatient healthcare database, the researchers from BUSM found cardiac events were the most common complication and occurred in 8% of the Medicare patients, more than twice the rate of patients with private insurance. Urinary tract infections and surgery-related complications were the next most-frequent complications overall, and both were more commonly seen in patients with Medicare or Medicaid. Urinary tract infection was seen in 3% of Medicare patients and nearly 3% of Medicaid/uninsured patients, compared with 1.8% of privately insured patients.

    After controlling for age, sex, and other demographic factors and comorbidities between Medicare and private insurance, patients with Medicare insurance had significantly higher risks of developing central nervous system complications, gastrointestinal complications, wound breakdown, and postoperative anemia. They also had an increased rate of mortality compared with patients with private insurance. There were no significant differences in the medical complications or mortality between publicly insured patients with Medicare versus Medicaid patients. These findings are similar to those of previous studies that found increased complications in patients with Medicaid insurance after TKA compared with 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 complications when stratifying patients preoperatively for knee replacement surgery. “Further research is needed to investigate the disparities in these findings to optimize patient outcomes following TKA.”