Do insurance and race represent independent predictors of undergoing total shoulder arthroplasty? A secondary data analysis of 3529 patients

doi:10.1016/j.jse.2011.02.007

Journal of Shoulder and Elbow Surgery

Volume 21, Issue 5, May 2012, Pages 661-666

https://doi.org/10.1016/j.jse.2011.02.007 Get rights and content

Hypothesis

Race and insurance status are independent predictors of the choice between total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) of the shoulder joint.

Background

Current literature shows that ethnic and socioeconomic status may influence access to health care. However, no study has demonstrated whether insurance status and race are independent predictors that patients with glenohumeral osteoarthritis will undergo TSA.

Materials and methods

Patients with primary International Classification of Diseases, 9th revision, Clinical Modification, procedure codes for TSA and HA were selected from the 1988 to 2007 United States Nationwide Inpatient Sample. Primary predictors were race (Caucasian, African American, Hispanic, other) and insurance status (private, Medicare, Medicaid, other). Multiple logistic regressions were used to determine whether insurance status and race were associated with the choice of procedure for patients presenting with glenohumeral osteoarthritis.

Results

The study included data for 3529 patients, of whom 2369 underwent TSA (67.1%) and the remaining 1160 (32.9%) underwent HA. Of patients treated using TSA, 29% were privately insured, 63.2% had Medicare, and 2.5% had Medicaid (P < .001), and 62.1% were Caucasian, 2.5% were African American, 2.46% were Hispanic, and 30.9% had other ethnicities (P < .001).

Discussion

Multiple logistic regression analysis found that privately insured patients and Medicare patients did not show statistically different odds of having TSA compared with patients within the Medicaid (reference category) or “other payment” categories, after adjustment for a variety of potential confounders. Caucasian patients also did not show statistically different chances of undergoing TSA compared with African Americans.

Conclusions

We were unable to support statistical evidence that race and insurance status are independent factors associated with the choice of the surgical procedure in patients with glenohumeral osteoarthritis.

Section snippets

Design and database

This was secondary analysis of the National Inpatient Sample (NIS) database, which is sponsored by the United States Agency for Healthcare Research and Quality. The dataset for each year contains information on 5 to 8 million inpatients from a sample of more than 1000 hospitals in 40 states.¹⁴ The data represent a 20% stratified sample of community hospitals in the USA, ensuring maximal representativeness of the population. The NIS was developed to analyze trends in health care use, cost,

Results

The study included data for 3529 patients, of whom 2369 (67.1%) underwent TSA and 1160 (32.9%) underwent HA. The distribution according to insurance status (Table I) was private insurance, 1026 (29%); Medicare, 2231 (63.2%); Medicaid, 88 (2.5%); and other, 184 (5.2%). Distribution according to race was Caucasian, 2194 (62.1%); African American, 89 (2.5%); Hispanic, 87 (2.46%); other, 67 (1.9%), and information about race was missing for 1092 patients (30.9%; Table II). We did not find

Discussion

To date, this is the only orthopedic surgery study analyzing whether insurance status and race are associated with the type of shoulder arthroplasty undergone by patients with glenohumeral degenerative disease. Using a representative USA health database, we performed risk adjustment for the main confounders (such as age, sex, race, insurance status, patient comorbidity, median ZIP code income, and hospital location and teaching status) and found that privately insured and Medicare patients did

Conclusion

We cannot support statistical evidence that race and insurance status are independent factors associated with the choice of surgical procedure in patients with glenohumeral osteoarthritis. Nonetheless, we suggest new studies for different orthopedic surgeries and also considering regional stratification.

Acknowledgment

We acknowledge Ricardo Pietrobon and team "Research on Research" Duke University Health System, USA for templates for writing the introduction and discussion sections of the manuscript (Shah J et al., 2009) and templates for the literature review (Pietrobon R et al, 2004); date of retrieval: May 3, 2010 http://researchonresearch.duhs.duke.edu/site/

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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This would seem to indicate that this condition is largely undiagnosed, resulting in an underestimation of patients with AUD. Despite these limitations, administrative databases such as the NIS have displayed effectiveness in answering complex questions.15,18,44 In this study, we compared perioperative death and complications, hospital stay, and nonroutine discharge in shoulder arthroplasty patients with and without AUDs.
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: Approval from the Duke Institutional Review Board (protocol ID: Pro00024291) was obtained before this project was initiated.

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ShoulderDo insurance and race represent independent predictors of undergoing total shoulder arthroplasty? A secondary data analysis of 3529 patients

Hypothesis

Background

Materials and methods

Results

Discussion

Conclusions

Section snippets

Design and database

Results

Discussion

Conclusion

Acknowledgment

Disclaimer

J Shoulder Elbow Surg

J Arthroplasty

J Chronic Dis

J Clin Epidemiol

J Shoulder Elbow Surg

Orthop Clin North Am

J Shoulder Elbow Surg

Osteoarthritis and Cartilage

Orthop Clin North Am

J Shoulder Elbow Surg

First-line treatment for osteoarthritis: Part 2: Nonpharmacologic interventions and evaluation

Orthop Nurs

Shoulder arthroplasty: indications, contraindications and complications

Panminerva Med

Shoulder arthroplasty for the treatment of inflammatory arthritis

J Bone Joint Surg Am

Shoulder
Do insurance and race represent independent predictors of undergoing total shoulder arthroplasty? A secondary data analysis of 3529 patients