ShoulderDo insurance and race represent independent predictors of undergoing total shoulder arthroplasty? A secondary data analysis of 3529 patients
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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Approval from the Duke Institutional Review Board (protocol ID: Pro00024291) was obtained before this project was initiated.