Actions for Medicaid insurance status predicts postoperative mortality after total knee arthroplasty in State Inpatient Databases

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Medicaid insurance status predicts postoperative mortality after total knee arthroplasty in State Inpatient Databases

Author
Maman, Stephan
Published
[University Park, Pennsylvania] : Pennsylvania State University, 2019.
Physical Description
1 electronic document
Additional Creators
Andreae, Michael
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Open Access.
Summary
Background: Social determinants of health, such as primary insurance status, may unduly impact morbidity and mortality after joint surgery. We hypothesized that Medicaid versus private primary insurance status predicts in-hospital mortality after total knee arthroplasty (TKA).Methods: We build regression models using generalized estimating equations with exchangeable correlation to test our hypothesis in patients in the State Inpatient Database from five states, who underwent primary TKA from January 2007 to December 2014.Results: Medicaid patients had greater odds of in-hospital mortality compared to patients with private insurance (OR 1.73, 95% CI 1.01 - 2.95). Corroborating our primary analysis as potential mediators, Medicaid patients were also more likely to experience any postoperative complications (OR 1.25, 95% CI 1.18 - 1.33), pulmonary complications (OR 1.26, 95% CI 1.16 - 1.36), infection-related complications (OR 1.51, 95% CI 1.35 - 1.68), intraoperative complications (OR 1.25, 95% CI 1.03 - 1.52), longer length of stay (OR 1.09, 95% CI 1.08 - 1.10), and greater total charges (OR 1.03, 95% CI 1.02 - 1.04) relative to privately insured patients.Conclusion: Medicaid insurance status is associated with higher in-hospital mortality and morbidity in patients after TKA compared to private insurance, even after controlling for potentially confounding patient characteristics and risk factors.
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Dissertation Note
M.S. Pennsylvania State University 2019.
Technical Details
The full text of the dissertation is available as an Adobe Acrobat .pdf file ; Adobe Acrobat Reader required to view the file.
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