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Kebeh M, Dlott CC, Kurek D, Tung WS, Morris JC, Wiznia DH. Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization: Payer Status and Medication Management-Part Six of the Movement Is Life Special ONJ Series. Orthop Nurs 2024; 43:195-201. [PMID: 39047269 PMCID: PMC11279383 DOI: 10.1097/nor.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
This article is the sixth in the Movement is Life series and focuses on insurance coverage and medication management in the perioperative period, 2 tangentially related variables that affect patient outcomes. Our aim is to use current practices and literature to develop recommendations for nurse navigators' execution of preoperative optimization protocols related to payer status and medication management. Discussions with nurse navigators and a literature search were used to gather information and develop recommendations specific to optimizing payer status and medication management. Nurse navigators connected patients to resources and provided education regarding financial concerns and medications, and findings from the literature discussed insurance status among TJA patients. Nurse navigators can contribute to payer status and medication management optimization by providing patient education and resource referrals. In addition, we recommend conducting repeated medication reconciliation and developing awareness of financial resources and perioperative medication management guidelines.
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Affiliation(s)
- Martha Kebeh
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Chloe C. Dlott
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Donna Kurek
- National Association of Orthopaedic Nurses and Movement is Life, Chicago, IL, USA
- OrthoVirginia, Chesterfield, VA, USA
| | - Wei Shao Tung
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jensa C. Morris
- Hospital Medicine Service, Yale New Haven Hospital, New Haven, CT, USA
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Daniel H. Wiznia
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Dubin J, Bains S, Ihekweazu UN, Mont MA, Delanois R. Social Determinants of Health in Total Joint Arthroplasty: Insurance. J Arthroplasty 2024; 39:1637-1639. [PMID: 38360281 DOI: 10.1016/j.arth.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Lin S, Sproul D, Agarwal A, Harris AB, Golladay GJ, Thakkar SC. Risk Factors Associated With Quadriceps Tendon Extensor Mechanism Disruption Following Total Knee Arthroplasty. J Arthroplasty 2024; 39:1840-1844.e1. [PMID: 38331356 DOI: 10.1016/j.arth.2024.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Quadriceps tendon extensor mechanism disruption is an infrequent but devastating complication after total knee arthroplasty (TKA). Our knowledge of specific risk factors for this complication is limited by the current literature. Thus, this study aimed to identify potential risk factors for quadriceps tendon extensor mechanism disruption following TKA. METHODS A retrospective cohort analysis was performed using the PearlDiver Administrative Claims Database. Patients undergoing TKA without a prior history of quadriceps tendon extensor mechanism disruption were identified. Quadriceps tendon extensor mechanism disruption included rupture of the quadriceps tendon, patellar tendon, or fracture of the patella. Patients who had a minimum of 5 years of follow-up after TKA were included. A total of 126,819 patients were included. Among them, 517 cases of quadriceps tendon extensor mechanism disruption occurred (incidence 0.41%). Hypothesized risk factors were compared between those who had postoperative quadriceps tendon extensor mechanism disruption and those who did not. RESULTS On multivariate analysis, increased Charlson Comorbidity Index (odds ratio (OR): 1.10, 95% confidence interval (CI) [1.07 to 1.13]; P < .001), obesity (OR: 1.49, 95% CI [1.24 to 1.79]; P < .001), and fluoroquinolone use any time after TKA (OR: 1.24, 95% CI [1.01 to 1.52]; P = .036) were significantly associated with quadriceps tendon extensor mechanism disruption. CONCLUSIONS Our study identified the incidence of quadriceps tendon extensor mechanism disruption following TKA as 0.41%. Identified risk factors for quadriceps tendon extensor mechanism disruption after TKA include an increased Charlson Comorbidity Index, obesity, and use of fluoroquinolones postoperatively.
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Affiliation(s)
- Shu Lin
- Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - David Sproul
- Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Amil Agarwal
- Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Andrew B Harris
- Adult Reconstruction Division, Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland
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Lin YS, DeClercq JJ, Ayers GD, Gilmor RJ, Collett G, Jain NB. Incidence and Clinical Risk Factors of Post-Operative Complications following Primary Total Hip Arthroplasty: A 10-Year Population-Based Cohort Study. J Clin Med 2023; 13:160. [PMID: 38202167 PMCID: PMC10780046 DOI: 10.3390/jcm13010160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Background: Total hip arthroplasty (THA) has become a growing treatment procedure for debilitating hip pathologies. Patients experienced post-operative complications and revision surgeries according to large THA registries. To fully understand the short-term and long-term post-operative outcomes following THA, the purpose of this study is to examine the incidence of post-operative complications following primary THA and to examine how this trend has changed over 10 years within community hospitals in the US using large databases. Methods: This study queried the State Inpatient Database (SID) for primary THA between 2006 and 2015. Individual patients were followed forward in time until the first instance of a post-operative complication. The multivariable logistic regression analyses were computed to examine which post-operative complications were independent predictors of pre-operative comorbidities. Results: Median age of patients was 67 years, and 56% of patients were female. Females with avascular necrosis (AVN) as an indication for THA had a 27% higher risk of complication. Females with osteoarthritis (OA) as an indication for THA had a 6% higher risk of complication. Post-operative complications occurred with higher frequencies in the first two months of THA and the highest risks of THA complications within the first 6 months. Conclusion: The most common indication is OA in elders with primary THA. Females and those of black ethnicity showed the greatest risks of THA complications. Data from our large study can be used to understand post-operative complications and readmissions after THA. Our study also provides data on risk factors associated with these complications.
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Affiliation(s)
- Yen-Sheng Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Joshua J. DeClercq
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | - Gregory D. Ayers
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
| | | | - Garen Collett
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
| | - Nitin B. Jain
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA; (Y.-S.L.); (G.C.)
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA (G.D.A.)
- Department of Population & Data Sciences, University of Texas Southwestern, Dallas, TX 75390, USA
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Pearson ZC, Ahiarakwe U, Bahoravitch TJ, Schmerler J, Harris AB, Thakkar SC, Best MJ, Srikumaran U. Social Determinants of Health Disparities Increase the Rate of Complications After Total Knee Arthroplasty. J Arthroplasty 2023; 38:2531-2536.e3. [PMID: 37659681 DOI: 10.1016/j.arth.2023.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Few studies have investigated whether social determinants of health disparities (SDHD), which include economic, social, education, health care, and environmental factors, identified through International Classification of Diseases (ICD) codes are associated with increased odds for poor health outcomes. We aimed to investigate the association between SDHD, identified through this novel methodology, as well as postoperative complications following total knee arthroplasty (TKA). METHODS Using a national insurance claims database, a retrospective cohort analysis was performed. Patients were selected using Current Procedural Terminology and ICD codes for primary TKA between 2010 and 2019. Patients were stratified into 2 groups using ICD codes, those who had SDHD and those who did not, and propensity matched 1:1 for age, sex, a comorbidity score, and other comorbidities. After matching, 207,844 patients were included, with 103,922 patients in each cohort. Odds ratios (ORs) for 90-day medical and 2-year surgical complications were obtained using multivariable logistical regressions. RESULTS In patients who have SDHD, multivariable analysis demonstrated higher odds of readmission (OR): 1.12; P = .013) and major and minor medical complications (OR: 2.09; P < .001) within 90-days as well as higher odds of revision surgery (OR: 1.77; P < .001) and periprosthetic joint infection (OR: 1.30; P < .001) within 2-years. CONCLUSION The SDHD are an independent risk factor for revision surgery and periprosthetic joint infection after TKA. In addition, SDHD is also an independent risk factor for all-cause hospital readmissions and both minor and major complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zachary C Pearson
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Uzoma Ahiarakwe
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Tyler J Bahoravitch
- The School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Mathew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Shah NV, Moattari CR, Lavian JD, Gedailovich S, Krasnyanskiy B, Beyer GA, Condron N, Passias PG, Lafage R, Jo Kim H, Schwab FJ, Lafage V, Paulino CB, Diebo BG. The Impact of Isolated Preoperative Cannabis Use on Outcomes Following Cervical Spinal Fusion: A Propensity Score-Matched Analysis. THE IOWA ORTHOPAEDIC JOURNAL 2023; 43:117-124. [PMID: 38213849 PMCID: PMC10777691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Cannabis is the most commonly used recreational drug in the USA. Studies evaluating cannabis use and its impact on outcomes following cervical spinal fusion (CF) are limited. This study sought to assess the impact of isolated (exclusive) cannabis use on postoperative outcomes following CF by analyzing outcomes like complications, readmissions, and revisions. Methods The New York Statewide Planning and Research Cooperative System (SPARCS) was queried for patients who underwent CF between January 2009 and September 2013. Inclusion criteria were age ≥18 years and either a minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Patients with systemic disease, osteomyelitis, cancer, trauma, and concomitant substance or polysubstance abuse/dependence were excluded. Patients with a preoperative International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis of isolated cannabis abuse (Cannabis) or dependence were identified. The primary outcome measures were 90-day complications, 90-day readmissions, and two-year revisions following CF. Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, surgical approach, and tobacco use to non-cannabis users and compared for outcomes. Multivariate binary stepwise logistic regression models identified independent predictors of outcomes. Results 432 patients (n=216 each) with comparable age, sex, Deyo scores, tobacco use, and distribution of anterior or posterior surgical approaches were identified (all p>0.05). Cannabis patients were predominantly Black (27.8% vs. 12.0%), primarily utilized Medicaid (29.6% vs. 12.5%), and had longer LOS (3.0 vs. 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical and surgical, as well as overall complications (5.6% vs. 3.7%) and two-year revisions (4.2% vs. 2.8%, p=0.430), but isolated cannabis patients had higher 90-day readmission rates (11.6% vs. 6.0%, p=0.042). Isolated cannabis use independently predicted 90-day readmission (Odds Ratio=2.0), but did not predict any 90-day complications or two year revisions (all p>0.05). Conclusion Isolated baseline cannabis dependence/abuse was associated with increased risk of 90-day readmission following CF. Further investigation of the physiologic impact of cannabis on musculoskeletal patients may elucidate significant contributory factors. Level of Evidence: III.
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Affiliation(s)
- Neil V. Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Cameron R. Moattari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Joshua D. Lavian
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Samuel Gedailovich
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Benjamin Krasnyanskiy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - George A. Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Nolan Condron
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Peter G. Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Frank J. Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Carl B. Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Bassel G. Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Mulugeta SG, MacDonald NC, El-Khoury CJ, Davis SL, Kenney RM. Impact of a Standardized, Pharmacist-Initiated "Test-Claim" Workflow for Anticipating Barriers to Accessing Discharge Antimicrobials. J Pharm Technol 2023; 39:218-223. [PMID: 37745731 PMCID: PMC10515972 DOI: 10.1177/87551225231196047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background: Inability to access and afford discharge oral antimicrobials may delay discharges or result in therapeutic failure. "Test-claims" have the potential to identify such barriers. Objective: This study evaluated discharge antimicrobial access and patient outcomes after implementation of a standardized, inpatient pharmacist-initiated antimicrobial discharge medication cost inquiry (aDMCI) process. Methods: This was an Institutional Review Board (IRB)-approved, pilot retrospective cohort study that included adults admitted for ≥72 hours from November 1, 2018, to February 28, 2019, and discharged on oral antimicrobials. Patients with a cost inquiry (aDMCI group) were compared with those without (standard-of-care, SOC, group). Primary endpoint was discharge delay. Secondary endpoints included percentage of patients discharged on suboptimal antimicrobials and medication errors from aDMCI. Results: 84 patients were included: 43 in SOC and 41 in aDMCI. Seventy-five antimicrobial cost inquiries were evaluated among 41 patients. There were no discharge delays or medication errors associated with the standardized "test-claim" (aDMCI) workflow. Patients in the SOC group had a greater Charlson Comorbidity Index (4 [2-6] vs 2 [1-4], P =0.004), were more likely to be immunosuppressed (24, 56% vs 12, 29%; P =0.014), and had longer hospitalization (8 [5-15] vs 6 [5-9] days, P =0.026). Primary access barriers were prior-authorization (8, 11%) and associated with linezolid and moxifloxacin cost inquiries. Most aDMCIs results were available in <24 hours (66, 88%). Conclusions: The aDMCI process is safe and offers an actionable transition of care tool that can identify barriers to accessing discharge medications while insulating patients from surprise out-of-pocket cost.
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Affiliation(s)
| | | | | | - Susan L Davis
- Pharmacy Division, Henry Ford Health, Detroit, MI, USA
- Wayne State University, Detroit, MI, USA
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Williamson CG, Richardson S, Ebrahimian S, Kronen E, Verma A, Benharash P. Identifying the origin of socioeconomic disparities in outcomes of major elective operations. Surg Open Sci 2023; 13:66-70. [PMID: 37181545 PMCID: PMC10173262 DOI: 10.1016/j.sopen.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/16/2023] Open
Abstract
Background While the impact of socioeconomic status (SES) on surgical outcomes has been examined in limited series, it remains a significant determinant of healthcare outcomes at the national level. Therefore, the current study aims to determine SES disparities at three time-points: hospital accessibility, in-hospital outcomes, and post-discharge consequences. Methods The Nationwide Readmissions Database 2010-2018 was used to isolate major elective operations. SES was assigned using previously coded median income quartiles as defined by patient zip-code, with low SES defined as the lowest quartile and high SES as the highest. Results Of an estimated 4,816,837 patients undergoing major elective operations, 1,037,689 (21.3 %) were categorized as low SES and 1,288,618 (26.5 %) as high. On univariate analysis and compared to those of low SES, high SES patients were more frequently treated at high-volume centers (70.9 vs 55.6 %, p < 0.001), had lower rates of in-hospital complications (24.0 vs 29.0 %, p < 0.001) and mortality (0.4 vs 0.9 %, p < 0.001) as well as less frequent urgent readmissions at 30- (5.7 vs 7.1 %, p < 0.001) and 90-day timepoints (9.4 vs 10.7 %, p < 0.001). On multivariable analysis, high SES patients had higher odds of treatment at high-volume centers (Odds: 1.87, 95 % CI: 1.71-2.06), and lower odds of perioperative complications (Odds: 0.98, 95 % CI: 0.96-0.99), mortality (Odds: 0.70, 95 % CI: 0.65-0.75), and urgent readmissions at 90-days (Odds: 0.95, 95 % CI: 0.92-0.98). Conclusion This study fills a much-needed gap in the current literature by establishing that all of the aforementioned timepoints include significant disadvantages for those of low socioeconomic status. Therefore, a multidisciplinary approach may be required for intervention to improve equity for surgical patients.
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Affiliation(s)
| | | | | | | | | | - Peyman Benharash
- Corresponding author at: UCLA Center for Health Sciences, 10833 Le Conte Avenue, Room 62-249, Los Angeles, CA 90095, United States of America.
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Minimally invasive treatment of osteoarthritis of the hip joint by radiofrequency denervation: a clinical case. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract112285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background. At present, there is an increasing trend towards the spread of osteoarthritis among the population of Russia and the world, and therefore the search for an effective and low-traumatic method of stopping pain syndrome of directional exposure in coxarthrosis is an urgent and important problem of modern medicine.
Clinical Case Description. A clinical case of treatment of a 64-year-old patient, a working pensioner, with complaints of severe pain in the left hip joint and a clinical picture of stage IV coxarthrosis according to the Kellgren and Lawrence classification, is presented at the Multidisciplinary medical Center of the Bank of Russia. Previously, the patient was given indications for planned joint arthroplasty due to the ineffectiveness of conservative treatment courses. The pain syndrome on the visual analogue scale (VAS) was 9 points, according to the Harris Hip Score 32 points (unsatisfactory result). In connection with the development of an acute concomitant disease, radiofrequency denervation (RFD) of the left hip joint was performed with discharge the next day and a positive outcome in the form of a decrease in pain for a long period. VAS: 1st day - 3 points, 1 month - 2 points, 6 months - 6 points, 12 months - 7 points, as well as according to the "Harris Hip Score": 1 month after the test 82 points (good result), after 6 months 76 points (satisfactory result)
Conclusion. As this clinical case showed, RFD is an alternative for patients with osteoarthritis of the hip joint who are contraindicated in total arthroplasty, and conservative treatment does not give long-term positive results in severe pain.
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McLeish T, Seadler BD, Parrado R, Rein L, Joyce DL. The effect of socioeconomic factors on patient outcomes in cardiac surgery. J Card Surg 2022; 37:5135-5143. [PMID: 36403269 DOI: 10.1111/jocs.17229] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Healthcare delivery is heterogenous; the reasons for this are numerous and complex. Patient-specific factors including geography, income, insurance status, age, and gender have been shown to bias surgical outcomes. Utilizing a prospectively collected all-payer database, we aim to evaluate the influence of socioeconomic factors on mortality and length of stay (LOS) after common cardiac surgical procedures. METHODS We utilized the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality for the year 2019. We included patients undergoing coronary artery bypass grafting (CABG), aortic valve replacement (AVR), transcatheter aortic valve replacement (TAVR), and combined AVR/CABG using the 10th revision of the International Classification of Diseases procedure codes. AVR and CABG were combined into a separate cohort as this was felt to represent a different pathology than isolated valvular or coronary arterial disease. Baseline demographics were summarized. Multivariable regression was performed within each procedure group to model the odds of in-hospital mortality and hospital LOS with age, sex, insurance, zip-code median household income, and location as predictors. RESULTS Baseline patient characteristics including gender, income, geography, and payer status were similar between CABG, AVR, and AVR/CABG. TAVR patients had a higher proportion of female sex and Medicare as the primary payer, with an overall greater age. Multivariable Cox proportional hazards regression found that higher income was strongly associated with decreased LOS following AVR and CABG, and moderately associated in TAVR and AVR/CABG. Private insurance was associated with a decreased LOS in patients undergoing CABG, AVR, TAVR, and AVR/CABG. Female sex and increased age were associated with increased odds of mortality in TAVR, CABG, and AVR/CABG. Private insurance was associated with a decreased odds of mortality in patients undergoing AVR. CONCLUSIONS These findings reveal significant disparities in patient outcomes after routine cardiac operations that are associated with socioeconomic status. Patients who did not have private insurance or had lower incomes were found to be at risk for increased LOS. Women were at a higher risk of mortality for several operations, a finding which has been previously described elsewhere. Private insurance conveyed a decreased odds of mortality in patients undergoing AVR. This data set serves to highlight differences in healthcare outcomes based on a variety of socioeconomic, geographic, and other inherent factors. Additional research is needed to identify the mechanisms behind these disparities with the goal of providing equitable care to all patients.
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Affiliation(s)
- Tyson McLeish
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Benjamin D Seadler
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Raphael Parrado
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa Rein
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David L Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Alvarez PM, McKeon JF, Spitzer AI, Krueger CA, Pigott M, Li M, Vajapey SP. Socioeconomic factors affecting outcomes in total knee and hip arthroplasty: a systematic review on healthcare disparities. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:36. [PMID: 36184658 PMCID: PMC9528115 DOI: 10.1186/s42836-022-00137-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/13/2022] [Indexed: 11/07/2022]
Abstract
Background Recent studies showed that healthcare disparities exist in use of and outcomes after total joint arthroplasty (TJA). This systematic review was designed to evaluate the currently available evidence regarding the effect socioeconomic factors, like income, insurance type, hospital volume, and geographic location, have on utilization of and outcomes after lower extremity arthroplasty. Methods A comprehensive search of the literature was performed by querying the MEDLINE database using keywords such as, but not limited to, “disparities”, “arthroplasty”, “income”, “insurance”, “outcomes”, and “hospital volume” in all possible combinations. Any study written in English and consisting of level of evidence I-IV published over the last 20 years was considered for inclusion. Quantitative and qualitative analyses were performed on the data. Results A total of 44 studies that met inclusion and quality criteria were included for analysis. Hospital volume is inversely correlated with complication rate after TJA. Insurance type may not be a surrogate for socioeconomic status and, instead, represent an independent prognosticator for outcomes after TJA. Patients in the lower-income brackets may have poorer access to TJA and higher readmission risk but have equivalent outcomes after TJA compared to patients in higher income brackets. Rural patients have higher utilization of TJA compared to urban patients. Conclusion This systematic review shows that insurance type, socioeconomic status, hospital volume, and geographic location can have significant impact on patients’ access to, utilization of, and outcomes after TJA. Level of evidence IV. Supplementary Information The online version contains supplementary material available at 10.1186/s42836-022-00137-4.
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Affiliation(s)
- Paul M. Alvarez
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
| | - John F. McKeon
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Andrew I. Spitzer
- grid.50956.3f0000 0001 2152 9905Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, USA
| | - Chad A. Krueger
- grid.512234.30000 0004 7638 387XDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Matthew Pigott
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Mengnai Li
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Sravya P. Vajapey
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
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Dekeseredy P, Hickman WP, Fang W, Sedney CL. Traumatic spinal cord injury in West Virginia: Impact on long-term outcomes by insurance status and discharge disposition. J Neurosci Rural Pract 2022; 13:652-657. [PMID: 36743754 PMCID: PMC9893939 DOI: 10.25259/jnrp-2022-3-53-r1-(2492)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Specialized rehabilitation is important for people with traumatic spinal cord injuries (SCIs) to optimize function, independence and mitigate complications, and access to this service varies by the payor. In West Virginia, admission to acute rehabilitation facilities is a "non-covered entity," impeding access to this care for patients with SCI and Medicaid. Our previous work examined the discharge disposition from an acute care hospital of patients with and without Medicaid and found that Medicaid patients were almost twice as likely to be discharged home or to a nursing home, despite similar injury severity and younger age compared to non-Medicaid patients. West Virginia is a largely rural state with multiple health-care challenges. A lack of availability of rehabilitation facilities for Medicaid beneficiaries likely explains this difference. This present study examines the relationship between insurance coverage, discharge disposition at time of injury, and long-term outcomes for people in West Virginia with traumatic SCI. Materials and Methods This study utilized a retrospective chart review and telephone survey from a Level 1 Trauma Center in West Virginia. Participants included 200 patients with traumatic SCI from 2009 to 2016 in West Virginia. Thirty-four patients completed the survey through telephone interviews, with another 16 completing the survey but declining to answer economic questions. Survey participants were asked the Craig Handicap Assessment and Reporting Technique (CHART), which indicates the degree of impairment, and disability; they experience years after initial injury and rehabilitation. Proportional odds regression models, a regression model generalization of the Wilcoxon rank sum test, were employed where normal distribution of the response variables was not assumed and was performed, controlling for age and injury severity. Results Total CHART score correlated with discharge disposition (P = 0.01). Insurance type correlated with mobility sub-score (P = 0.03). Conclusion Patients discharged to a rehabilitation center have overall higher CHART scores post-injury, indicating better long-term outcomes than those discharged home or a nursing home. People with Medicaid as payors had lower scores for mobility than those with other insurance coverage.
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Affiliation(s)
| | | | - Wei Fang
- West Virginia Clinical and Translational Science Institute, Erma Byrd Biomedical Research Center, Morgantown, West Virginia
| | - Cara L. Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
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13
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Dlott CC, Wiznia DH. CORR Synthesis: How Might the Preoperative Management of Risk Factors Influence Healthcare Disparities in Total Joint Arthroplasty? Clin Orthop Relat Res 2022; 480:872-890. [PMID: 35302972 PMCID: PMC9029894 DOI: 10.1097/corr.0000000000002177] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/24/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Chloe C. Dlott
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Daniel H. Wiznia
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Abstract
The United States healthcare system underperforms in healthcare access, quality, and cost resulting in some of the poorest health outcomes among comparable countries, despite spending more of its gross national product on healthcare than any other country in the world. Within the United States, there are significant healthcare disparities based on race, ethnicity, socioeconomic status, education level, sexual orientation, gender identity, and geographic location. COVID-19 has illuminated the racial disparities in health outcomes. This article provides an overview of some of the main concepts related to health disparities generally, and in orthopaedics specifically. It provides an introduction to health equity terminology, issues of bias and equity, and potential interventions to achieve equity and social justice by addressing commonly asked questions and then introduces the reader to persistent orthopaedic health disparities specific to total hip and total knee arthroplasty.
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Affiliation(s)
- Susan Salmond
- Susan Salmond, EdD, RN, ANEF, FAAN, School of Nursing, Rutgers University-The State University of New Jersey, Newark
| | - Caroline Dorsen
- Susan Salmond, EdD, RN, ANEF, FAAN, School of Nursing, Rutgers University-The State University of New Jersey, Newark
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15
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Yayac M, D'Antonio N, Star AM, Austin MS, Courtney PM. Demand Matching and Site of Care: High-Cost Facilities Do Not Improve Short-term Quality Metrics Following Total Hip and Knee Arthroplasty. Orthopedics 2022; 45:19-24. [PMID: 34846241 DOI: 10.3928/01477447-20211124-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With increased emphasis on improving value in total hip arthroplasty (THA) and total knee arthroplasty (TKA) care, concerns exist about whether variability in hospital costs between facilities is justified. The purpose of this study was to compare index facility reimbursement among hospitals and short-term outcomes for patients undergoing primary THA and TKA. We queried a single private insurer's claims data, identifying all patients undergoing THA or TKA from 2015 to 2017 performed by 25 surgeons across 16 hospitals within our institution. Hospitals were divided into high- and low-cost facilities based on mean index reimbursement. We compared comorbidities, episode-of-care costs, and short-term outcomes between facilities and performed multivariate analyses. Of 2963 procedures, 1305 (44%) were performed at higher-cost hospitals. Higher-cost facilities had higher mean index reimbursement ($40,597 vs $26,781, P<.0001) and higher mean Charlson Comorbidity Index (CCI; 0.32 vs 0.24, P=.0029), but no difference in complications (2.2% vs 1.8%, P=.3955) or readmissions (2.2% vs 1.5%, P=.1490). On multivariate analyses, higher-cost facility increased index reimbursement by $13,780 (95% CI, $13,489-$14,071, P<.0001) and discharge to facility risk (odds ratio [OR], 3.2; 95% CI, 1.9-5.4; P<.0001), but not complication (OR, 1.2; 95% CI, 0.7-2.0; P=.5983) or readmission (OR, 1.5; 95% CI, 0.9-2.6; P=.1474) risks. Shifting 25% of patients with a CCI of 0 from higher- to lower-cost centers would have decreased inpatient facility costs by an estimated $3,582,784. Wide variability exists between hospital facility costs for THA and TKA without differences in short-term outcomes. Demand matching healthier patients to lower-cost facilities may significantly lower the overall procedural costs of THA and TKA. [Orthopedics. 2022;45(1):19-24.].
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16
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Sharma A, Farley KX, Schwartz AM, Wilson JM, Bradbury TL, Guild GN. Medicaid Payer Status Is Associated With Increased 90-Day Resource Utilization, Reoperation, and Infection Following Aseptic Revision Total Hip Arthroplasty. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:66-74. [PMID: 36601230 PMCID: PMC9769354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Prior literature has demonstrated increased resource utilization and perioperative complications in patients with a Medicaid payor status undergoing primary total hip and knee arthroplasty. This relationship has yet to be explored in patients undergoing revision total hip arthroplasty (rTHA). Methods The National Readmissions Database was queried from 2010 to 2015 for all patients undergoing aseptic rTHA. 90-day complication data were collected, and patients were separated into two cohorts based on insurance payor type: Medicaid and non-Medicaid. Patients were propensity score matched 2:1 on a number of comorbid and operative characteristics. The relationship between Medicaid payor status and postoperative outcomes was then assessed using binomial logistic regression analysis. Results 3,110 Medicaid patients were identified and matched to 6,175 non-Medicaid patients. Medicaid patients had increased odds of an early prosthetic joint infection (Odds Ratio [OR] 1.29, p=0.019), superficial surgical site infection (OR: 1.48, p=0.003), and early reoperation (OR: 1.18, p=0.045). Medicaid patients also experienced higher odds of readmissions, extended length of stay, non-home discharge status, and medical complications. Finally, the Medicaid cohort had a $3,332 (95% CI: 2,412-4,253, p<0.001) increased adjusted total cost of care when compared to the non-Medicaid cohort. Conclusion This study identifies the Medicaid payor status as an independent risk factor for increased resource utilization, reoperation, and infection in the early postoperative period for patients undergoing rTHA. This relationship is likely due to an interplay of multiple variables, including socioeconomic status and access to care. Level of Evidence: IV.
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Affiliation(s)
- Aman Sharma
- Emory University Orthopaedics & Spine Hospital, Tucker, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kevin X Farley
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew M Schwartz
- Emory University Orthopaedics & Spine Hospital, Tucker, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jacob M Wilson
- Emory University Orthopaedics & Spine Hospital, Tucker, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas L Bradbury
- Emory University Orthopaedics & Spine Hospital, Tucker, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
| | - George N Guild
- Emory University Orthopaedics & Spine Hospital, Tucker, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
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17
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Singh JA, Cleveland JD. Serious Infections in Patients With Gout in the US: A National Study of Incidence, Time Trends, and Outcomes. Arthritis Care Res (Hoboken) 2021; 73:898-908. [PMID: 32248660 DOI: 10.1002/acr.24201] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To study the epidemiology of serious infections in patients hospitalized with gout. METHODS We identified patients with gout hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), or opportunistic infections (OIs) in a US National Inpatient Sample from 1998 to 2016 and examined factors associated with utilization and mortality. RESULTS We noted 1,140,085 hospitalizations of patients with serious infections and gout (11% of all hospitalizations of patients with gout; 1998-2000 [8.9%], 2015-2016 [14.5%]). Compared to patients without gout, patients with gout hospitalized with serious infections were older (median age 65 versus 74 years), more of them had a Charlson-Deyo comorbidity index score ≥2 (42% versus 65%), and fewer were female (53% versus 35%) or non-White (40% versus 35%), respectively. The most common infection was pneumonia (52%) in 1998-2000 and sepsis (52%) in 2015-2016. Median hospital charges and hospital stays were higher for patients with sepsis and OIs in 2015-2016 ($41,000-$42,000; 5.1-5.5 days) versus those with UTI, pneumonia, or SSTIs ($15,000-$17,000; 3.0-3.9 days). Compared to patients with sepsis, the multivariable-adjusted odds of health care utilization and in-hospital mortality were significantly lower for patients with UTI, SSTIs, and pneumonia, and non-home discharge or in-hospital mortality were lower in patients with OIs. Among patients hospitalized with infections, older age, Medicaid coverage, a higher Charlson-Deyo comorbidity index score, Black race, and Northeast and nonrural hospital location were associated with significantly higher health care utilization and mortality, while female sex, Medicare insurance, and lower income were associated with higher utilization. CONCLUSION Given an increasing rate of serious infections, especially sepsis and pneumonia, in individuals with gout, development of effective interventions targeting factors associated with health care utilization and mortality will improve outcomes and reduce burden.
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18
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Stevens TT, Hartline JT, Ojo O, Grear BJ, Richardson DR, Murphy GA, Bettin CC. Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses. Foot Ankle Int 2021; 42:894-901. [PMID: 33588617 DOI: 10.1177/1071100721990343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study looked at the effect of patient demographics, insurance status, education, and patient opinion on whether various orthotic footwear prescribed for a variety of diagnoses were received by the patient. The study also assessed the effect of the orthoses on relief of symptoms. METHODS Chart review documented patient demographics, diagnoses, and medical comorbidities. Eligible patients completed a survey either while in the clinic or by phone after their clinic visit. RESULTS Of the 382 patients prescribed orthoses, 235 (61.5%) received their orthoses; 186 (48.7%) filled out the survey. Race and whether or not the patient received the orthosis were found to be significant predictors of survey completion. Race, type of insurance, and amount of orthotic cost covered by insurance were significant predictors of whether or not patients received their prescribed orthoses. Type of orthosis, diabetes as a comorbidity, education, income, sex, and diagnosis were not significant predictors of whether the patient received the orthosis. Qualitative results from the survey revealed that among those receiving their orthoses, 87% experienced improvement in symptoms: 21% felt completely relieved, 66% felt better, 10% felt no different, and 3% felt worse. CONCLUSION We found that white patients had almost 3 times the odds of receiving prescribed orthoses as black patients, even after controlling for type of insurance, suggesting race to be the primary driver of discrepancies, raising the question of what can be done to address these inequalities. While large, systematic change will be necessary, some strategies can be employed by those working directly in patient care, such as informing primary care practices of their ability to see patients with limited insurance, limiting blanket refusal policies for government insurance, and educating office staff on how to efficiently work with Medicare and Medicaid. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Trenton T Stevens
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | | | | | - Benjamin J Grear
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - David R Richardson
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - G Andrew Murphy
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Clayton C Bettin
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
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19
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Association of Medicaid Expansion with In-Hospital Outcomes After Abdominal Aortic Aneurysm Repair. J Surg Res 2021; 266:201-212. [PMID: 34022654 DOI: 10.1016/j.jss.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/08/2021] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Multiple studies have shown improved outcomes and higher utilization of care with the increase of insurance coverage. This study aims to assess whether Medicaid expansion (ME) has changed the utilization and outcomes of abdominal aortic aneurysm (AAA) repair in the United States. DESIGN Retrospective observational study. MATERIALS Data of patients undergoing AAA repair in the Vascular Quality Initiative (2010-2017). METHODS Interrupted time-series (ITS) analysis was utilized to evaluate changes in annual trends of postoperative outcomes after elective AAA repair before and after 2014. We also assessed if these trend changes were significant by comparing the changes in states which adopted ME in 2014 versus nonexpansion states (NME), and conducting a difference-in-difference analysis. Primary outcomes included in-hospital mortality and adverse events (bowel and leg ischemia, cardiac, renal, respiratory, stroke and return to the OR). RESULTS A total of 19,143 procedures were included (Endovascular: 85.8% and open: 14.2%), of which 40.9% were performed in ME States. Compared to preexpansion trends (P1), there was a 2% annual increase in elective AAA repair in ME states (P1: -1.8% versus P2: +0.2%, P< 0.01) with no significant change in NME (P1: +0.3% versus P2: +0.2%, P = 0.97). Among elective cases, annual trends in the use of EVAR increased by 2% in ME states (95% confidence interval (CI) = -0.1, 4.1, P = 0.06), compared to a 3% decrease in NME States [95%CI = -5.8, -0.6, P = 0.01) (PMEversusNME < 0.01]. There was no association between ME and in-hospital mortality. Nonetheless, it was associated with a decrease in the annual trends of in-hospital complications (ME: -1.4% (-2.1,-0.8) versus NME: +0.2% (-0.2, +0.8), P < 0.01). CONCLUSIONS While no association between ME and increased survival was noted in states which adopted ME, there was a significant increase of elective AAA cases and EVAR utilization and a decrease in in-hospital complications in ME States.
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20
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Kelleher DC, Lippell R, Lui B, Ma X, Tedore T, Weinberg R, White RS. Hospital safety-net burden is associated with increased inpatient mortality after elective total knee arthroplasty: a retrospective multistate review, 2007-2018. Reg Anesth Pain Med 2021; 46:663-670. [PMID: 33990442 DOI: 10.1136/rapm-2020-101731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is among the most common surgical procedures performed in the USA and comprises an outsized proportion of Medicare expenditures. Previous work-associated higher safety-net burden hospitals with increased morbidity and in-hospital mortality following total hip arthroplasty. Here, we examine the association of safety-net burden on postoperative outcomes after TKA. METHODS We retrospectively analyzed 1 141 587 patients aged ≥18 years undergoing isolated elective TKA using data from the State Inpatient Databases for Florida, Kentucky, Maryland, New York and Washington from 2007 through 2018. Hospitals were grouped into tertiles by safety-net burden status, defined by the proportion of inpatient cases billed to Medicaid or unpaid (low: 0%-16.83%, medium: 16.84%-30.45%, high: ≥30.45%). Using generalized estimating equation models, we assessed the association of hospital safety-net burden status on in-hospital mortality, patient complications and length of stay (LOS). We also analyzed outcomes by anesthesia type in New York State (NYS), the only state with this data. RESULTS Most TKA procedures were performed at medium safety-net burden hospitals (n=6 16 915, 54%), while high-burden hospitals performed the fewest (n=2 04 784, 17.9%). Overall in-patient mortality was low (0.056%), however, patients undergoing TKA at medium-burden hospitals were 40% more likely to die when compared with patients at low-burden hospitals (low: 0.043% vs medium: 0.061%, adjusted OR (aOR): 1.40, 95% CI 1.09 to 1.79, p=0.008). Patients who underwent TKA at medium or high safety-net burden hospitals were more likely to experience intraoperative complications (low: 0.2% vs medium: 0.3%, aOR: 1.94, 95% CI 1.34 to 2.83, p<0.001; low: 0.2% vs high: 0.4%, aOR: 1.91, 95% CI 1.35 to 2.72, p<0.001). There were no statistically significant differences in other postoperative complications or LOS between the different safety-net levels. In NYS, TKA performed at high safety-net burden hospitals was more likely to use general rather than regional anesthesia (low: 26.7% vs high: 59.5%, aOR: 4.04, 95% CI 1.05 to 15.5, p=0.042). CONCLUSIONS Patients undergoing TKA at higher safety-net burden hospitals are associated with higher odds of in-patient mortality than those at low safety-net burden hospitals. The source of this mortality differential is unknown but could be related to the increased risk of intraoperative complications at higher burden centers.
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Affiliation(s)
| | - Ryan Lippell
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Briana Lui
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Xiaoyue Ma
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Tiffany Tedore
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Roniel Weinberg
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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21
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Racial and socioeconomic disparities among patients undergoing hip arthroplasty: a New York State population analysis. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Hammer M, Althoff FC, Platzbecker K, Wachtendorf LJ, Teja B, Raub D, Schaefer MS, Wongtangman K, Xu X, Houle TT, Eikermann M, Murugappan KR. Discharge Prediction for Patients Undergoing Inpatient Surgery: Development and validation of the DEPENDENSE score. Acta Anaesthesiol Scand 2021; 65:607-617. [PMID: 33404097 DOI: 10.1111/aas.13778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/09/2020] [Accepted: 12/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND A substantial proportion of patients undergoing inpatient surgery each year is at risk for postoperative institutionalization and loss of independence. Reliable individualized preoperative prediction of adverse discharge can facilitate advanced care planning and shared decision making. METHODS Using hospital registry data from previously home-dwelling adults undergoing inpatient surgery, we retrospectively developed and externally validated a score predicting adverse discharge. Multivariable logistic regression analysis and bootstrapping were used to develop the score. Adverse discharge was defined as in-hospital mortality or discharge to a skilled nursing facility. The model was subsequently externally validated in a cohort of patients from an independent hospital. RESULTS In total, 106 164 patients in the development cohort and 92 962 patients in the validation cohort were included, of which 16 624 (15.7%) and 7717 (8.3%) patients experienced adverse discharge, respectively. The model was predictive of adverse discharge with an area under the receiver operating characteristic curve (AUC) of 0.87 (95% CI 0.87-0.88) in the development cohort and an AUC of 0.86 (95% CI 0.86-0.87) in the validation cohort. CONCLUSION Using preoperatively available data, we developed and validated a prediction instrument for adverse discharge following inpatient surgery. Reliable prediction of this patient centered outcome can facilitate individualized operative planning to maximize value of care.
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Affiliation(s)
- Maximilian Hammer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Friederike C Althoff
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Katharina Platzbecker
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Bijan Teja
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Raub
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
- Department of Anaesthesiology, Dusseldorf University Hospital, Dusseldorf, Germany
| | - Karuna Wongtangman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
- Department of Anaesthesiology and Intensive Care Medicine, Duisburg-Essen University, Essen, Germany
| | - Kadhiresan R Murugappan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
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23
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Zhang D, Pan L, Maimaitijuma T, Liu H, Wu H. Imaging Analysis of Prosthesis Angle after Hip Replacement with Direct Anterior Approach in Lateral Position. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5540834. [PMID: 33680413 PMCID: PMC7904353 DOI: 10.1155/2021/5540834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
The use of lateral DAA-THA for the treatment of end-stage hip disorders has good recent clinical efficacy, does not require special surgical beds and traction equipment, uses traditional surgical instruments, reduces the requirements for surgical beds and surgical instruments, enters through the nerve and muscle anatomical gap without cutting any muscle or nerve tissue, is minimally invasive, and has good surgical maneuverability, low bleeding, low postoperative pain, short hospitalization time, and rapid recovery. It is a safe and effective minimally invasive procedure because of its light weight, short hospital stay, and rapid recovery. In this paper, we used imaging to observe the angle of the posterior prosthesis. And the results showed that hip arthroplasty using the direct anterior approach improved hip mobility in early stages compared with other approaches and reduced pain. The direct anterior approach and length between total hip arthroplasty using direct lateral and posterior lateral approach and partial data (surgical time, blood loss, etc.) were significantly worse than those using direct forward approach. In addition, the direct anterior approach to total hip arthroplasty is subject to a learning curve and requires at least 33 cases of experience to achieve a lower complication rate.
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Affiliation(s)
- Daojian Zhang
- Peking University First Hospital, Beijing 100034, China
| | - Liping Pan
- Peking University First Hospital, Beijing 100034, China
| | | | - Heng Liu
- Peking University First Hospital, Beijing 100034, China
| | - Hao Wu
- Peking University First Hospital, Beijing 100034, China
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The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations. J Am Assoc Nurse Pract 2021; 33:1190-1197. [PMID: 33534285 DOI: 10.1097/jxx.0000000000000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. PURPOSE To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. METHODS A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition-related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. RESULTS As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = -2.218; 95% confidence interval [CI]: -3.79 to -0.644 and p = .04; β = -2.698; 95% CI: -5.268 to -0.127, respectively). IMPLICATIONS FOR PRACTICE Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.
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Lamoshi A, Rothstein DH. Risk Factors for Inpatient Mortality in Patients Born with Gastroschisis in the United States. Am J Perinatol 2021; 38:60-64. [PMID: 31412402 DOI: 10.1055/s-0039-1694732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to characterize risk factors for inpatient mortality in patients born with gastroschisis in a contemporary cohort. STUDY DESIGN This was a retrospective cohort study of infants born with gastroschisis using the Kids' Inpatient Database 2016. Simple descriptive statistics were used to characterize the patients by demographics, and illness severity was estimated using the All-Patient Refined Diagnosis-Related Groups classification. Variables associated with an increased risk of mortality on univariate analysis were incorporated into a multivariable logistic regression model to generate adjusted odds ratios (aORs) for mortality. RESULTS An estimated 1,990 patient with gastroschisis were born in 2016, with a 3.7% mortality rate during the initial hospitalization. Multivariable logistic regression demonstrated the following variables to be associated with an increased risk of inpatient mortality: black or Asian race compared with white (aOR: 2.6, 95% confidence interval [CI]: 1.1-6.1, p = 0.03 and aOR: 4.1, 95% CI: 1.3-13.3, p = 0.02, respectively), whereas private health insurance compared with government (aOR: 0.2; 95% CI: 0.2-0.8; p = 0.007) and exurban domicile compared with urban (aOR: 0.5; 95% CI: 0.2-0.9; p = 0.04) appeared to be associated with a decreased risk of inpatient mortality. CONCLUSION Inpatient mortality for neonates with gastroschisis is relatively low. Even after correcting for illness severity, race, health insurance status, and domicile appear to play a role in mortality disparities. Opportunities may exist to further decrease mortality in at-risk populations.
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Affiliation(s)
- Abdulraouf Lamoshi
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
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Post-operative outcomes and anesthesia type in total hip arthroplasty in patients with obstructive sleep apnea: A retrospective analysis of the State Inpatient Databases. J Clin Anesth 2020; 69:110159. [PMID: 33348291 DOI: 10.1016/j.jclinane.2020.110159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES To investigate postoperative outcomes following total hip arthroplasty (THA) in patients with obstructive sleep apnea (OSA). To evaluate trends in the use of regional anesthesia (RA) versus general anesthesia (GA) following the publication of practical guidelines. To compare postoperative outcomes according to anesthesia type. DESIGN Retrospective analysis. SETTING Operating room. PATIENTS 349,008 patients who underwent elective THA in Florida, New York, Maryland, and Kentucky between 2007 and 2014 were extracted from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, including 18,063 patients with OSA (5.2%). INTERVENTIONS No intervention. MEASUREMENTS The effect of OSA on postoperative outcomes was investigated using bivariate analysis and multivariable logistic regression models. Outcomes studied included in-hospital mortality, postoperative complications, length of stay (LOS), and post-discharge readmissions. In a population from New York only, (n = 105,838 with 5306 patients with OSA [5.0%]), we investigated the outcomes in the OSA population according to the anesthesia type. Analysis was performed overall and for each individual year. MAIN RESULTS The OSA prevalence increased from 1.7% in 2007 to 7.1% in 2014. In multivariable analysis, there was no effect of OSA on in-hospital mortality (aOR:0.57; 0.31-1.04). Postoperative complications, LOS, and readmission rates were all higher in patients with OSA. In patients with OSA receiving GA than those receiving RA, we found a higher rate of complications overall and pulmonary complications specifically in men and higher rate of 90-day readmission in women. Over the study period, the rate of GA use in patients with OSA increased. CONCLUSIONS The OSA prevalence in patients undergoing THA increased fourfold over the study period. OSA was associated with increased overall postoperative complications, LOS, and readmission, but not with in-hospital mortality. Despite the publication of guidelines favoring RA over GA, the use of GA increased over the study period.
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Ehsan A, Zeymo A, Cohen BD, McDermott J, Shara NM, Sellke FW, Sodha N, Al-Refaie WB. Cardiac Surgery Utilization Across Vulnerable Persons After Medicaid Expansion. Ann Thorac Surg 2020; 112:786-793. [PMID: 33188751 DOI: 10.1016/j.athoracsur.2020.08.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/13/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Medicaid expansion (ME) under the Affordable Care Act has reduced the number of uninsured patients, although its preferential effects on vulnerable populations have been mixed. This study examined whether ME preferentially improved cardiac surgery use by insurance strata, race, and income level. METHODS Non-elderly adults (aged 18-64 years) who underwent coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or mitral valve repair were identified in the State Inpatient Databases for 3 expansion states (Kentucky, New Jersey, and Maryland) and 2 non-expansion states (North Carolina and Florida) from 2012 to the third quarter of 2015. We used adjusted Poisson interrupted time series to determine the impact of ME on cardiac surgery use for Medicaid or uninsured (MCD/UIS) patients, racial and ethnic minorities, and individuals from low-income areas. RESULTS In expansion states, use among non-White MCD/UIS patients had a positive trend after ME (2.3%/quarter; P = .156), whereas use for White MCD/UIS patients fell (-1.7%/quarter; P = .117). In contrast, use among non-White MCD/UIS in non-expansion states decreased by 4.4% (P < .001) which was a greater decline than among White MCD/UIS patients (-1.8%/quarter; P = .057). There was no substantial effect of ME on cardiac surgery use for MCD/UIS patients from low- versus high-income areas. CONCLUSIONS These findings demonstrate that the use of cardiac surgical procedures was generally unchanged after ME; however, nonsignificant trend differences suggest a narrowing gap between vulnerable and non-vulnerable groups in ME states. These preliminary findings help describe the association of insurance coverage as a driver of cardiac surgery use among vulnerable patients.
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Affiliation(s)
- Afshin Ehsan
- Division of Cardiothoracic Surgery, Brown University Medical School-Rhode Island Hospital, Providence, Rhode Island
| | - Alexander Zeymo
- MedStar Health Research Institute, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
| | - Brian D Cohen
- Department of Surgery, MedStar-Georgetown University Medical Center, Washington, DC; MedStar Health Research Institute, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
| | - James McDermott
- MedStar Health Research Institute, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
| | - Nawar M Shara
- MedStar Health Research Institute, Washington, DC; Center for Clinical and Translational Science, Georgetown-Howard Universities, Washington, DC
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Brown University Medical School-Rhode Island Hospital, Providence, Rhode Island
| | - Neel Sodha
- Division of Cardiothoracic Surgery, Brown University Medical School-Rhode Island Hospital, Providence, Rhode Island
| | - Waddah B Al-Refaie
- Department of Surgery, MedStar-Georgetown University Medical Center, Washington, DC; MedStar Health Research Institute, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC.
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Grobaty L, Lajam C, Hutzler L. Impact of Value-Based Reimbursement on Health-Care Disparities for Total Joint Arthroplasty Candidates. JBJS Rev 2020; 8:e2000073. [PMID: 33186211 DOI: 10.2106/jbjs.rvw.20.00073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
As the U.S. Centers for Medicare & Medicaid Services (CMS) implements value-based reimbursement models based on predetermined outcome measures, access to total joint arthroplasty (TJA) is jeopardized for patients who are disproportionately affected by conditions that predispose them to higher odds of complications. Obesity, depression, and chronic illness, each of which occur at disproportionately higher rates in minorities or individuals in lower socioeconomic brackets, are individually associated with worse TJA postoperative outcomes, including longer hospital lengths of stay and higher rates of readmission within 90 days. Medicaid may even be considered an independent risk factor for worse outcome measures with TJA as enrollees have higher rates of postoperative mortality and complications and longer lengths of stay than patients on Medicare or with private insurance.
As same-day discharge for TJA becomes more common, eligibility requirements for the procedure tighten, and existing disparities in access to the procedure will be further exacerbated. The current CMS uniform quality metrics endanger access to TJA for patients in certain racial and socioeconomic groups and oblige physicians who treat more complex patients to jeopardize their reimbursement.
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Affiliation(s)
- Lauren Grobaty
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY
| | - Claudette Lajam
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY
| | - Lorraine Hutzler
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY
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Sha S, Du W, Parkinson A, Glasgow N. Relative importance of clinical and sociodemographic factors in association with post-operative in-hospital deaths in colorectal cancer patients in New South Wales: An artificial neural network approach. J Eval Clin Pract 2020; 26:1389-1398. [PMID: 31733029 DOI: 10.1111/jep.13318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Co-morbidities in colorectal cancer patients complicate hospital care, and their relative importance to post-operative deaths is largely unknown. This study was conducted to examine a range of clinical and sociodemographic factors in relation to post-operative in-hospital deaths in colorectal cancer patients and identify whether these contributions would vary by severity of co-morbidities. METHODS In this multicentre retrospective cohort study, we used the complete census of New South Wales inpatient data to select colorectal cancer patients admitted to public hospitals for acute surgical care, who underwent procedures on the digestive system during the period of July 2001 to June 2014. The primary outcome was in-hospital death at the end of acute care. Multilayer perceptron and back-propagation artificial neural networks (ANNs) were used to quantify the relative importance of a wide range of clinical and sociodemographic factors in relation to post-operative deaths, stratified by severity of co-morbidities based on Charlson co-morbidity index. RESULTS Of 6288 colorectal cancer patients, approximately 58.3% (n = 3669) had moderate to severe co-morbidities. A total of 464 (7.4%) died in hospitals. The performance for ANN models was superior to logistic models. Co-morbid musculoskeletal and mental disorders, adverse events in health care, and socio-economic factors including rural residence and private insurance status contributed to post-operative deaths in hospitals. CONCLUSION Identification of relative importance of factors contributing to in-hospital deaths in colorectal cancer patients using ANN may help to enhance patient-centred strategies to meet complex needs during acute surgical care and prevent post-operative in-hospital deaths.
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Affiliation(s)
- Sha Sha
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Wei Du
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Nicholas Glasgow
- Research School of Population Health, Australian National University, Canberra, Australia
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Smith BC, Morrison CP, Pauls RN. Complications and Month of Surgery: Does Scheduling Make a Difference? J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Benjamin C. Smith
- Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, Ohio, USA
| | - Christopher P. Morrison
- Division of Obstetrics and Gynecology, TriHealth, Good Samaritan Hospital, Cincinnati, Ohio, USA
| | - Rachel N. Pauls
- Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, Ohio, USA
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Bonine NG, Banks E, Harrington A, Vlahiotis A, Moore-Schiltz L, Gillard P. Contemporary treatment utilization among women diagnosed with symptomatic uterine fibroids in the United States. BMC Womens Health 2020; 20:174. [PMID: 32791970 PMCID: PMC7427077 DOI: 10.1186/s12905-020-01005-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 06/28/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study evaluated treatment patterns among women diagnosed with symptomatic uterine fibroids (UF) in the United States. Data were retrospectively extracted from the IBM Watson Health MarketScan® Commercial Claims and Encounters and Medicaid Multi-State databases. METHODS Women aged 18-64 years with ≥1 medical claim with a UF diagnosis (primary position, or secondary position plus ≥1 associated symptom) from January 2010 to June 2015 (Commercial) and January 2009 to December 2014 (Medicaid) were eligible; the first UF claim during these time periods was designated the index date. Data collected 12 months pre- and 12 and 60 months post-diagnosis included clinical/demographic characteristics, pharmacologic/surgical treatments, and surgical complications. Prevalence (2015) and cumulative incidence (Commercial, 2010-2015; Medicaid, 2009-2015) of symptomatic UF were estimated. RESULTS 225,737 (Commercial) and 19,062 (Medicaid) women had a minimum of 12 months post-index continuous enrollment and were eligible for study. Symptomatic UF prevalence and cumulative incidence were: 0.57, 1.23% (Commercial) and 0.46, 0.64% (Medicaid). Initial treatments within 12 months post-diagnosis were surgical (Commercial, 36.7%; Medicaid, 28.7%), pharmacologic (31.7%; 53.0%), or none (31.6%; 18.3%). Pharmacologic treatments were most commonly non-steroidal anti-inflammatory drugs and oral contraceptives; hysterectomy was the most common surgical treatment. Of procedures of abdominal hysterectomy, abdominal myomectomy, uterine artery embolization, and ablation in the first 12 months post-index, 14.9% (Commercial) and 24.9% (Medicaid) resulted in a treatment-associated complication. Abdominal hysterectomy had the highest complication rates (Commercial, 18.5%; Medicaid, 31.0%). CONCLUSIONS Off-label use of pharmacologic therapies and hysterectomy for treatment of symptomatic UF suggests a need for indicated non-invasive treatments for symptomatic UF.
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Affiliation(s)
- Nicole Gidaya Bonine
- Health Economics & Outcomes Research - Canada, Allergan plc, 500 - 85 Enterprise Blvd, Markham, ON, L6G 0B5, Canada.
| | - Erika Banks
- Montefiore Medical Center, Bronx, New York, USA
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Roof MA, Feng JE, Anoushiravani AA, Schoof LH, Friedlander S, Lajam CM, Vigdorchik J, Slover JD, Schwarzkopf R. The effect of patient point of entry and Medicaid status on quality outcomes following total hip arthroplasty. Bone Joint J 2020; 102-B:78-84. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1424.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Previous studies have reported an increased risk for postoperative complications in the Medicaid population undergoing total hip arthroplasty (THA). These studies have not controlled for the surgeon’s practice or patient care setting. This study aims to evaluate whether patient point of entry and Medicaid status plays a role in quality outcomes and discharge disposition following THA. Methods The electronic medical record at our institution was retrospectively reviewed for all primary, unilateral THA between January 2016 and January 2018. THA recipients were categorized as either Medicaid or non-Medicaid patients based on a visit to our institution’s Hospital Ambulatory Care Center (HACC) within the six months prior to surgery. Only patients who had been operated on by surgeons (CML, JV, JDS, RS) with at least ten Medicaid and ten non-Medicaid patients were included in the study. The patients included in this study were 56.33% female, had a mean age of 60.85 years, and had a mean BMI of 29.14. The average length of follow-up was 343.73 days. Results A total of 426 hips in 403 patients were included in this study, with 114 Medicaid patients and 312 non-Medicaid patients. Medicaid patients had a significantly lower mean age (54.68 years (SD 12.33) vs 63.10 years (SD 12.38); p < 0.001), more likely to be black or ‘other’ race (27.19% vs 13.46% black; 26.32% vs 12.82% other; p < 0.001), and more likely to be a current smoker (19.30% vs 9.29%; p = 0.001). After adjusting for patient risk factors, there was a significant Medicaid effect on length of stay (LOS) (rate ratio 1.129, 95% confidence interval (CI) 1.048 to 1.216; p = 0.001) and facility discharge (odds ratio 2.010, 95% CI 1.398 to 2.890; p < 0.001). There was no Medicaid effect on surgical time (exponentiated β coefficient 1.015, 95% CI 0.995 to 1.036; p = 0.136). There was no difference in 30-day readmission, 90-day readmission, 30-day infections, 90-day infections, and 90-day mortality between the two groups. Conclusion After controlling for patient variables, there was a statistically significant Medicaid effect on LOS and facility discharge. These results indicate that clinically similar outcomes can be achieved for Medicaid patients; however, further work is needed on maximizing social support and preoperative patient education with a focus on successful home discharge. Cite this article: Bone Joint J 2020;102-B(7 Supple B):78–84.
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Affiliation(s)
- Mackenzie A. Roof
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - James E. Feng
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan, USA
| | | | - Lauren H. Schoof
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Scott Friedlander
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Claudette M. Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Jonathan Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - James D. Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Hoyler MM, Tam CW, Thalappillil R, Jiang S, Ma X, Lui B, White RS. The impact of hospital safety‐net burden on mortality and readmission after CABG surgery. J Card Surg 2020; 35:2232-2241. [DOI: 10.1111/jocs.14738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marguerite M. Hoyler
- Department of AnesthesiologyNew York‐Presbyterian/Weill Cornell Medical Center New York New York
| | - Christopher W. Tam
- Department of AnesthesiologyNew York‐Presbyterian/Weill Cornell Medical Center New York New York
| | - Richard Thalappillil
- Department of AnesthesiologyNew York‐Presbyterian/Weill Cornell Medical Center New York New York
| | - Silis Jiang
- Department of Anesthesiology, Center for Perioperative OutcomesNew York‐Presbyterian/Weill Cornell Medical Center New York New York
| | - Xiaoyue Ma
- Department of Healthcare Policy and ResearchWeill Cornell Medicine New York New York
| | - Briana Lui
- Department of Anesthesiology, Center for Perioperative OutcomesNew York‐Presbyterian/Weill Cornell Medical Center New York New York
| | - Robert S. White
- Department of AnesthesiologyNew York‐Presbyterian/Weill Cornell Medical Center New York New York
- Department of Anesthesiology, Center for Perioperative OutcomesNew York‐Presbyterian/Weill Cornell Medical Center New York New York
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Andreae MH, Maman SR, Behnam AJ. An Electronic Medical Record-Derived Individualized Performance Metric to Measure Risk-Adjusted Adherence with Perioperative Prophylactic Bundles for Health Care Disparity Research and Implementation Science. Appl Clin Inform 2020; 11:497-514. [PMID: 32726836 PMCID: PMC7390620 DOI: 10.1055/s-0040-1714692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/01/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Health care disparity persists despite vigorous countermeasures. Clinician performance is paramount for equitable care processes and outcomes. However, precise and valid individual performance measures remain elusive. OBJECTIVES We sought to develop a generalizable, rigorous, risk-adjusted metric for individual clinician performance (MIP) derived directly from the electronic medical record (EMR) to provide visual, personalized feedback. METHODS We conceptualized MIP as risk responsiveness, i.e., administering an increasing number of interventions contingent on patient risk. We embedded MIP in a hierarchical statistical model, reflecting contemporary nested health care delivery. We tested MIP by investigating the adherence with prophylactic bundles to reduce the risk of postoperative nausea and vomiting (PONV), retrieving PONV risk factors and prophylactic antiemetic interventions from the EMR. We explored the impact of social determinants of health on MIP. RESULTS We extracted data from the EMR on 25,980 elective anesthesia cases performed at Penn State Milton S. Hershey Medical Center between June 3, 2018 and March 31, 2019. Limiting the data by anesthesia Current Procedural Terminology code and to complete cases with PONV risk and antiemetic interventions, we evaluated the performance of 83 anesthesia clinicians on 2,211 anesthesia cases. Our metric demonstrated considerable variance between clinicians in the adherence to risk-adjusted utilization of antiemetic interventions. Risk seemed to drive utilization only in few clinicians. We demonstrated the impact of social determinants of health on MIP, illustrating its utility for health science and disparity research. CONCLUSION The strength of our novel measure of individual clinician performance is its generalizability, as well as its intuitive graphical representation of risk-adjusted individual performance. However, accuracy, precision and validity, stability over time, sensitivity to system perturbations, and acceptance among clinicians remain to be evaluated.
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Affiliation(s)
- Michael H. Andreae
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Stephan R. Maman
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
- Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Abrahm J. Behnam
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
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Chen SA, White RS, Tangel V, Gupta S, Stambough JB, Gaber-Baylis LK, Weinberg R. Preexisting Opioid Use Disorder and Outcomes After Lower Extremity Arthroplasty: A Multistate Analysis, 2007–2014. PAIN MEDICINE 2020; 21:3624-3634. [DOI: 10.1093/pm/pnaa059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Objective
The aim of this study was to examine the association of preexisting opioid use disorder and postoperative outcomes in patients undergoing total hip or knee arthroplasty (THA and TKA, respectively) in the overall population and in the Medicare-only population.
Methods
This retrospective cohort study examined data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for the years 2007–2014 from California, Florida, New York, Maryland, and Kentucky. We compared patients with and without opioid use disorders on unadjusted rates and calculated adjusted odds ratios (aORs) of in-hospital mortality, postoperative complications, length of stay, and 30-day and 90-day readmission status; analyses were repeated in a subgroup of Medicare insurance patients only.
Subjects
After applying our exclusion criteria, our study included 1,422,210 adult patients undergoing lower extremity arthroplasties, including 818,931 Medicare insurance patients. In our study, 0.4% of THA patients and 0.3% of TKA patients had present-on-admission opioid use disorder.
Results
Opioid use disorder patients were at higher risk for in-hospital mortality (aOR = 3.10), 30- and 90-day readmissions (aORs = 1.81, 1.81), and pulmonary and infectious complications (aORs = 1.25, 1.96).
Conclusions
Present-on-admission opioid use disorder was a risk factor for worse postoperative outcomes and increased health care utilization in the lower extremity arthroplasty population. Opioid use disorder is a potentially modifiable risk factor for mortality, postoperative complications, and health care utilization, especially in the at-risk Medicare population.
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Affiliation(s)
- Stephanie A Chen
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Virginia Tangel
- Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Soham Gupta
- Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Licia K Gaber-Baylis
- Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Roniel Weinberg
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
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Rozental O, Ma X, Weinberg R, Gadalla F, Essien UR, White RS. Disparities in mortality after abdominal aortic aneurysm repair are linked to insurance status. J Vasc Surg 2020; 72:1691-1700.e5. [PMID: 32173191 DOI: 10.1016/j.jvs.2020.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/11/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this study was to determine differences in mortality after abdominal aortic aneurysm (AAA) repair based on insurance type. METHODS In this retrospective cohort study, data from all-payer patients in nonpsychiatric hospitals in New York, Maryland, Florida, Kentucky, and California from January 2007 to December 2014 (excluding California, ending December 2011) were extracted from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. There were 90,102 patients ≥18 years old with available insurance data who underwent open AAA repair or endovascular aneurysm repair (EVAR) identified using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes 3844, 3925, and 3971. EVAR patients were identified using the procedure code 3971, and the remainder of cases were categorized as open. Patients were divided into cohorts by insurance type as Medicare, Medicaid, uninsured (self-pay/no charge), other, or private insurance. Patients were further stratified for subgroup analyses by procedure type. Unadjusted rates of in-hospital mortality, the primary outcome, as well as secondary outcomes, such as surgical urgency, 30-day and 90-day readmissions, length of stay, total charges, and postoperative complications, were examined by insurance type. Adjusted odds ratios (ORs) for in-hospital mortality were calculated using multivariate logistic regression models fitted to the data. The multivariate models included patient-, surgical-, and hospital-specific factors with bivariate baseline testing suggestive of association with insurance status in addition to variables that were selected a priori. RESULTS Medicaid and uninsured patients had the highest rates of mortality relative to private insurance beneficiaries in all cohorts. Medicaid patients incurred a 47% increase in the odds of mortality, the highest among the insured, after all AAA repairs (OR, 1.47; 95% confidence interval [CI], 1.23-1.76), whereas uninsured patients experienced a 102% increase in the odds of mortality (OR, 2.02; 95% CI, 1.54-2.67). Subgroup analyses for open AAA repair and EVAR corroborated that Medicaid insurance (open repair OR, 1.37 [95% CI, 1.14-1.64]; EVAR OR, 2.06 [95% CI, 1.40-3.04]) and uninsured status (open repair OR, 1.85 [95% CI, 1.35-2.54]; EVAR OR, 2.96 [95% CI, 1.82-4.81]) were associated with the highest odds of mortality after both procedures separately. CONCLUSIONS This study demonstrates that Medicaid insurance and uninsured status are associated with higher unadjusted rates and adjusted ORs for in-hospital mortality after AAA repair relative to private insurance status. Primary payer status therefore serves as an independent predictor of the risk of death subsequent to AAA surgical interventions.
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Affiliation(s)
- Olga Rozental
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY; Department of Anesthesiology, NewYork-Presbyterian Hospital, New York, NY
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Roniel Weinberg
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY; Department of Anesthesiology, NewYork-Presbyterian Hospital, New York, NY
| | - Farida Gadalla
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY; Department of Anesthesiology, NewYork-Presbyterian Hospital, New York, NY
| | - Utibe R Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Healthy Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pa
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY; Department of Anesthesiology, NewYork-Presbyterian Hospital, New York, NY.
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Brumm J, White RS, Arroyo NS, Gaber-Baylis LK, Gupta S, Turnbull ZA, Mehta N. Sickle Cell Disease is Associated with Increased Morbidity, Resource Utilization, and Readmissions after Common Abdominal Surgeries: A Multistate Analysis, 2007-2014. J Natl Med Assoc 2020; 112:198-208. [PMID: 32089275 DOI: 10.1016/j.jnma.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD), the most commonly inherited hemoglobinopathy in the United States, increases the likelihood of postoperative complications, resulting in higher costs and readmissions. We used a retrospective cohort study to explore SCD's influence on postoperative complications and readmissions after cholecystectomy, appendectomy, and hysterectomy. METHODS We used an administrative database's 2007-2014 data from California, Florida, New York, Maryland, and Kentucky. RESULTS 1,934,562 patients aged ≥18 years were included. Compared to non-SCD patients, SCD patients experienced worse outcomes: increased odds of blood transfusion and major and minor complications, higher adjusted odds of 30- and 90-day readmissions, longer length of stay, and higher total hospital charges. CONCLUSION Sickle cell disease patients are at high risk for poor outcomes based on their demographic characteristics. Therefore, perioperative physicians including hematologists, anesthesiologists, and surgeons need to take this knowledge into consideration for management and counselling of SCD patients on the risks of surgery and recovery.
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Affiliation(s)
- John Brumm
- NewYork-Presbyterian Hospital - Weill Cornell Medicine, USA
| | - Robert S White
- NewYork-Presbyterian Hospital - Weill Cornell Medicine, USA.
| | - Noelle S Arroyo
- Weill Cornell Medicine Center for Perioperative Outcomes, USA
| | | | - Soham Gupta
- Weill Cornell Medicine Center for Perioperative Outcomes, USA
| | | | - Neel Mehta
- NewYork-Presbyterian Hospital - Weill Cornell Medicine, USA
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Coffield E, Thirunavukkarasu S, Ho E, Munnangi S, Angus LDG. Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals. BMC Health Serv Res 2020; 20:100. [PMID: 32041586 PMCID: PMC7011469 DOI: 10.1186/s12913-020-4896-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022] Open
Abstract
Background Length of hospital stay (LOS) for hip fracture treatments is associated with mortality. In addition to patient demographic and clinical factors, hospital and payer type may also influence LOS, and thus mortality, among hip fracture patients; accordingly, outcome disparities between groups may arise from where patients are treated and from their health insurance type. The purpose of this study was to examine if where hip fracture patients are treated and how they pay for their care is associated with outcome disparities between patient groups. Specifically, we examined whether LOS differed between patients treated at safety-net and non-safety-net hospitals and whether LOS was associated with patients’ insurance type within each hospital category. Methods A sample of 48,948 hip fracture patients was extracted from New York State’s Statewide Planning and Research Cooperative System (SPARCS), 2014–2016. Using means comparison and X2 tests, differences between safety-net and non-safety-net hospitals on LOS and patient characteristics were examined. Relationships between LOS and hospital category (safety-net or non-safety-net) and LOS and insurance type were further evaluated through negative binomial regression models. Results LOS was statistically (p ≤ 0.001) longer in safety-net hospitals (7.37 days) relative to non-safety-net hospitals (6.34 days). Treatment in a safety-net hospital was associated with a LOS that was 11.7% (p = 0.003) longer than in a non-safety-net hospital. Having Medicaid was associated with a longer LOS relative to having commercial health insurance. Conclusion Where hip fracture patients are treated is associated with LOS and may influence outcome disparities between groups. Future research should examine whether outcome differences between safety-net and non-safety-net hospitals are associated with resource availability and hospital payer mix.
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Affiliation(s)
- Edward Coffield
- Department of Health Professions, Hofstra University, 262 Swim Center, 220 Hofstra University, Hempstead, NY, 11549-2200, USA.
| | - Saeyoan Thirunavukkarasu
- Department of Data Analytics, Alliance for Positive Change, 64 West 35th Street, New York, NY, 10001, USA
| | - Emily Ho
- Department of Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
| | - Swapna Munnangi
- Department of Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
| | - L D George Angus
- Department of Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY, 11554, USA
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Lui B, White RS. Letter to the Editor: reporting and analyses of sex/gender and race/ethnicity in randomized controlled trials of interventions published in the highest-ranking anesthesiology journals. J Comp Eff Res 2020; 9:227-228. [PMID: 31992052 DOI: 10.2217/cer-2019-0195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Briana Lui
- Weill Cornell Medicine, Center for Perioperative Outcomes, Department of Anesthesiology, 428 East 72nd Street, Suite 800A, New York, NY 10021, USA
| | - Robert S White
- Weill Cornell Medicine, Department of Anesthesiology, 525 East 68th Street, Box 124, New York, NY 10065, USA
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Panchap L, Safavynia SA, Tangel V, White RS. Socioeconomic Disparities in Carotid Revascularization Procedures. J Cardiothorac Vasc Anesth 2020; 34:1836-1845. [PMID: 31917077 DOI: 10.1053/j.jvca.2019.11.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Several studies have demonstrated healthcare disparities in postoperative outcomes after carotid endarterectomy and carotid artery stenting, including increased hospital mortality, postoperative stroke, and readmission rates. The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures. DESIGN Records of adults from 2007 to 2014 were retrospectively identified, and patients with appropriate International Classification of Diseases Ninth Revision Clinical Modification codes for carotid endarterectomy or carotid artery stenting were identified. Primary outcomes were unadjusted rates and adjusted odds ratios (aORs) of postoperative in-hospital mortality, stroke, combined stroke/mortality, and cardiovascular complications. SETTING Data were sourced from the State Inpatient Databases data from California, Florida, Kentucky, Maryland, and New York during the years 2007 to 2014. PARTICIPANTS Patients undergoing carotid revascularization procedures. INTERVENTIONS The effects of race and insurance status as independent variables and as effect modifiers on postoperative outcomes. MEASUREMENTS AND MAIN RESULTS Multivariable logistic regression models were used to examine the associations between race and/or insurance status with respect to study outcomes. Race, but not payer status, was significantly associated with adverse outcomes after carotid artery procedures, with blacks, Hispanics, and other non-Caucasian races demonstrating a significantly greater risk of postoperative stroke and mortality (aOR range 1.24-1.59). This relationship persisted even when stratified by procedure type (aOR range 1.25-1.56) and symptomatology (aOR range 1.51-1.63). CONCLUSIONS These results suggest that disparities in postoperative outcomes after carotid artery procedures are associated with race but not with primary insurance status. Multiple contributing factors exist, including racial inequities in prevalence of comorbidities, health literacy, and procedure type performed.
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Affiliation(s)
- Latha Panchap
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | | | - Virginia Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
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Sedney CL, Khan U, Dekeseredy P. Traumatic spinal cord injury in West Virginia: Disparities by insurance and discharge disposition from an acute care hospital. J Spinal Cord Med 2020; 43:106-110. [PMID: 30508405 PMCID: PMC7006673 DOI: 10.1080/10790268.2018.1544878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Context: Medicaid has been linked to worse outcomes in a variety of diagnoses such as lung cancer, uterine cancer, and cardiac valve procedures. It has furthermore been linked to the reduced health-related quality of life outcomes after traumatic injuries when compared to other insurance groups. In spinal cord injury (SCI), the care provided in the subacute setting may vary based upon payor status, which may have implications on outcomes and cost of care.Design: A retrospective review utilizing the institutional trauma databank was performed for all adult patients with spinal cord injury since 2009. Pediatric patients were excluded. Insurance type, race, length of stay, discharge status (alive/dead), discharge disposition, injury severity score (ISS), and hospital charges billed were recorded.Results: Two hundred patients were identified. Overall 27.5% of patients with SCI during the period of our review were Medicaid beneficiaries. ISS was similar between Medicaid and non-Medicaid patients, but the Medicaid beneficiaries were younger (37 vs 50 years of age; P < .001). Medicaid beneficiaries had a significantly longer length of stay (20.9 days; P < .001) when compared to all other patients. They furthermore were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center. Inpatient charges billed for Medicaid beneficiaries were significantly higher than those of non-Medicaid patients (203,264 USD vs 140,114 USD; P = .015), likely reflecting the increased length of stay while awaiting appropriate disposition.Conclusion: Medicaid patients with SCI in West Virginia had a longer hospital stay, higher charges billed, and were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center, when compared to non-Medicaid patients. The lack of availability of rehabilitation facilities for Medicaid beneficiaries likely explains this difference.
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Affiliation(s)
- Cara L. Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Uzer Khan
- Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
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Park HS, White RS, Ma X, Lui B, Pryor KO. Social determinants of health and their impact on postcolectomy surgery readmissions: a multistate analysis, 2009–2014. J Comp Eff Res 2019; 8:1365-1379. [DOI: 10.2217/cer-2019-0114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: To examine the effect of race/ethnicity, insurance status and median household income on postoperative readmissions following colectomy. Patients & methods: Multivariate analysis of hospital discharge data from California, Florida, Maryland and New York from 2009 to 2014. Primary outcomes included adjusted odds of 30- and 90-day readmissions following colectomy by race, insurance status and median income quartile. Results: Total 330,840 discharges included. All 30-day readmissions were higher for black patients (adjusted odds ratio [aOR]: 1.07). Both 30- and 90-day readmissions were higher for Medicaid (aOR: 1.30 and 1.26) and Medicare (aOR: 1.30 and 1.29). The 30- and 90-day readmissions were lower in the highest income quartiles. Conclusion: Race, insurance status and median household income are all independent predictors of disparity in readmissions following colectomy.
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Affiliation(s)
- Hyun S Park
- Weill Cornell Medicine/New York Presbyterian Hospital, Department of Anesthesiology, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Robert S White
- Weill Cornell Medicine/New York Presbyterian Hospital, Department of Anesthesiology, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Xiaoyue Ma
- Weill Cornell Medicine, Division of Biostatistics & Epidemiology, Department of Healthcare Policy & Research, 402 East 67th Street, Box 74, New York, NY 10065, USA
| | - Briana Lui
- Weill Cornell Medicine/New York Presbyterian Hospital, Department of Anesthesiology, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Kane O Pryor
- Weill Cornell Medicine/New York Presbyterian Hospital, Department of Anesthesiology, 525 East 68th Street, Box 124, New York, NY 10065, USA
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Shi L, Truong K, Chen L, Basco W. Burden of non-fatal opioid overdose hospitalizations on Medicaid. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1640303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Liwei Chen
- Department of Epidemiology, University of California Los Angeles, Los Angeles, USA
| | - William Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, USA
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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; 8:1213-1228. [PMID: 31642330 DOI: 10.2217/cer-2019-0027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: Medicaid versus private primary insurance status may predict in-hospital mortality and morbidity after total knee arthroplasty (TKA). Materials & methods: Regression models were used to test our hypothesis in patients in the State Inpatient Database (SID) from five states who underwent primary TKA from January 2007 to December 2014. Results: Medicaid patients had greater odds of in-hospital mortality (odds ratio [OR]: 1.73; 95% CI: 1.01-2.95), greater odds of any postoperative complications (OR: 1.25; 95% CI: 1.18-1.33), experience longer lengths of stay (OR: 1.09; 95% CI: 1.08-1.10) and higher total charges (OR: 1.03; 95% CI: 1.02-1.04). Conclusion: Medicaid insurance status is associated with higher in-hospital mortality and morbidity in patients after TKA compared with private insurance.
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Affiliation(s)
- Stephan R Maman
- Penn State Milton S Hershey Medical Center, 500 University Drive, H187, Hershey, PA 17033, USA
| | - Michael H Andreae
- Penn State Milton S Hershey Medical Center, 500 University Drive, H187, Hershey, PA 17033, USA
| | - Licia K Gaber-Baylis
- Weill Cornell Medicine Center for Perioperative Outcomes, 428 East 72nd St., Ste 800A, New York, NY 10021, USA
| | - Zachary A Turnbull
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Robert S White
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
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Perlstein MD, Gupta S, Ma X, Rong LQ, Askin G, White RS. Abdominal Aortic Aneurysm Repair Readmissions and Disparities of Socioeconomic Status: A Multistate Analysis, 2007-2014. J Cardiothorac Vasc Anesth 2019; 33:2737-2745. [DOI: 10.1053/j.jvca.2019.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 01/14/2023]
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Response to Letter to the Editor on "Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty". J Arthroplasty 2019; 34:1857-1858. [PMID: 31036451 DOI: 10.1016/j.arth.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 02/01/2023] Open
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Who Cares for Total Hip Arthroplasty Complications? Rates of Readmission to a Hospital Different From the Location of the Index Procedure. J Am Acad Orthop Surg 2019; 27:e669-e675. [PMID: 30379760 DOI: 10.5435/jaaos-d-18-00464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION While the number of total hip arthroplasties (THAs) performed increases, so is the number of postoperative readmissions, resulting in costly episodes of care that may disproportionately affect certain hospitals. This study examines the rates of readmission of patients to the same hospital at which they underwent index THA, compared with readmission to a different hospital. METHODS Data for all hospital discharges from 1995 to 2010 were obtained from the California Office of Statewide Health Planning and Development database. Patient outcomes, readmission data, demographic information, hospital teaching status, and location were analyzed. Regression modeling was used to evaluate the effect of hospital teaching status, location, and individual complications on the risk of readmission to the same hospital as opposed to a different hospital following the index procedure. RESULTS The overall postoperative readmission rate for specific defined complications or all-cause 30-day readmissions was 3.92%, with 75.17% readmitted to the same hospital. Following index THA at a nonacademic or academic hospital, 95.9% and 84.6% of patients were readmitted to the same type of hospital, respectively. Patients who had their index procedure at an academic hospital had lower odds for readmission to the same hospital (odds ratio, 0.734; P < 0.0001) compared with nonacademic centers. Hospitals in midsize towns had higher odds of readmission to the same hospital (odds ratio, 1.735; P = 0.0012) compared with those in large metropolitan areas. DISCUSSION Although more than 75% of patients with unplanned readmissions went to the same hospital as their index THA, academic and larger metropolitan hospitals had higher odds of postoperative readmissions to a different hospital.
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Memtsoudis S, Cozowicz C, Zubizarreta N, Weinstein SM, Liu J, Kim DH, Poultsides L, Berger MM, Mazumdar M, Poeran J. Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: a retrospective population-based cohort study. Reg Anesth Pain Med 2019; 44:rapm-2019-100700. [PMID: 31302641 DOI: 10.1136/rapm-2019-100700] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/22/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND With an ageing population, the demand for joint arthroplasties and the burden of postoperative delirium is likely to increase. Given the lack of large-scale data, we investigated associations between perioperative risk factors and postoperative delirium in arthroplasty surgery. METHODS This retrospective population-based cohort study, utilized national claims data from the all-payer Premier Healthcare database containing detailed billing information from >25% nationwide hospitalizations. Patients undergoing elective total hip/knee arthroplasty surgery (2006-2016) were included.The primary outcome was postoperative delirium, while potential risk factors included age, gender, race, insurance type, and modifiable exposures including anesthesia type, opioid prescription dose (low/medium/high), benzodiazepines, meperidine, non-benzodiazepine hypnotics, ketamine, corticosteroids, and gabapentinoids. RESULTS Among 1 694 795 patients' postoperative delirium was seen in 2.6% (14 785/564 226) of hip and 2.9% (32 384/1 130 569) of knee arthroplasties. Multivariable models revealed that the utilization of long acting (OR 2.10 CI 1.82 to 2.42), combined long/short acting benzodiazepines (OR 1.74 CI 1.56 to 1.94), and gabapentinoids (OR 1.26 CI 1.16 to 1.36) was associated with increased odds of postoperative delirium. Lower odds of postoperative delirium were seen for neuraxial versus general anesthesia (OR 0.81 CI 0.70 to 0.93) and with the utilization of non-steroidal anti-inflammatory drugs (OR 0.85 CI 0.79 to 0.91) as well as cyclooxygenase-2 inhibitors (OR 0.82 CI 0.77 to 0.89). Age-stratified analysis revealed lower odds with high versus low opioid dose (OR 0.86 CI 0.76 to 0.98) in patients >65 years. Findings were consistent between hip and knee arthroplasties. CONCLUSIONS In this large national cohort, we identified various modifiable risk factors (including anesthesia type and pharmaceutical agents) for postoperative delirium, demonstrating possible prevention pathways.
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Affiliation(s)
- Stavros Memtsoudis
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery - Weill Cornell Medical College, New York, New York, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
- Department for Health Care Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery - Weill Cornell Medical College, New York, New York, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sarah M Weinstein
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery - Weill Cornell Medical College, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery - Weill Cornell Medical College, New York, New York, USA
| | - David H Kim
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery - Weill Cornell Medical College, New York, New York, USA
| | - Lazaros Poultsides
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Marc Moritz Berger
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Okike K, Chan PH, Prentice HA, Navarro RA, Hinman AD, Paxton EW. Association of Race and Ethnicity with Total Hip Arthroplasty Outcomes in a Universally Insured Population. J Bone Joint Surg Am 2019; 101:1160-1167. [PMID: 31274717 DOI: 10.2106/jbjs.18.01316] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prior studies have documented racial and ethnic disparities in total hip arthroplasty (THA) outcomes in the U.S. The purpose of this study was to assess whether racial/ethnic disparities in THA outcomes persist in a universally insured population of patients enrolled in an integrated health-care system. METHODS A U.S. health-care system total joint replacement registry was used to identify patients who underwent elective primary THA between 2001 and 2016. Data on patient demographics, surgical procedures, implant characteristics, and outcomes were obtained from the registry. The outcomes analyzed were lifetime revision (all-cause, aseptic, and septic) and 90-day postoperative events (infection, venous thromboembolism, emergency department [ED] visits, readmission, and mortality). Racial/ethnic differences in outcomes were analyzed with use of multiple regression with adjustment for socioeconomic status and other potential confounders. RESULTS Of 72,755 patients in the study, 79.1% were white, 8.2% were black, 8.5% were Hispanic, and 4.2% were Asian. Compared with white patients, lifetime all-cause revision was lower for black (adjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.66 to 0.94; p = 0.007), Hispanic (adjusted HR, 0.73; 95% CI, 0.61 to 0.87; p = 0.002), and Asian (adjusted HR, 0.49; 95% CI, 0.37 to 0.66; p < 0.001) patients. Ninety-day ED visits were more common among black (adjusted odds ratio [OR], 1.15; 95% CI, 1.05 to 1.25; p = 0.002) and Hispanic patients (adjusted OR, 1.18; 95% CI, 1.08 to 1.28; p < 0.001). For all other postoperative events, minority patients had similar or lower rates compared with white patients. CONCLUSIONS In contrast to prior research, we found that minority patients enrolled in a managed health-care system had rates of lifetime reoperation and 90-day postoperative events that were generally similar to or lower than those of white patients, findings that may be related to the equal access and/or standardized protocols associated with treatment in the managed care system. However, black and Hispanic patients still had higher rates of 90-day ED visits. Further research is required to determine the reasons for this finding and to identify interventions that could reduce unnecessary ED visits. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kanu Okike
- Hawaii Permanente Medical Group, Kaiser Permanente, Honolulu, Hawaii
| | - Priscilla H Chan
- Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California
| | - Heather A Prentice
- Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California
| | - Ronald A Navarro
- Southern California Permanente Medical Group, Kaiser Permanente, Harbor City, California
| | - Adrian D Hinman
- Northern California Permanente Medical Group, Kaiser Permanente, San Leandro, California
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California
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La M, Tangel V, Gupta S, Tedore T, White RS. Hospital safety net burden is associated with increased inpatient mortality and postoperative morbidity after total hip arthroplasty: a retrospective multistate review, 2007-2014. Reg Anesth Pain Med 2019; 44:rapm-2018-100305. [PMID: 31229962 DOI: 10.1136/rapm-2018-100305] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most widely performed surgical procedures in the USA. Safety net hospitals, defined as hospitals with a high proportion of cases billed to Medicaid or without insurance, deliver a significant portion of their care to vulnerable populations, but little is known about the effects of a hospital's safety net burden and its role in healthcare disparities and outcomes following THA. We quantified safety net burden and examined its impact on in-hospital mortality, complications and length of stay (LOS) in patients who underwent THA. METHODS We analyzed 500 189 patient discharge records for inpatient primary THA using data from the Healthcare Cost and Utilization Project's State Inpatient Databases for California, Florida, New York, Maryland and Kentucky from 2007 to 2014. We compared patient demographics, present-on-admission comorbidities and hospital characteristics by hospital safety net burden status. We estimated mixed-effect generalized linear models to assess hospital safety burden status' effect on in-hospital mortality, patient complications and LOS. RESULTS Patients undergoing THA at a hospital with a high or medium safety net burden were 38% and 30% more likely, respectively, to die in-hospital compared with those in a low safety net burden hospital (high adjusted OR: 1.38, 95% CI 1.10 to 1.73; medium adjusted OR: 1.30, 95% CI 1.07 to 1.57). Compared with patients treated in hospitals with a low safety net burden, patients treated in high safety net hospitals were more likely to develop a postoperative complication (adjusted OR: 1.11, 95% CI 1.00 to 1.24) and require a longer LOS (adjusted IRR: 1.06, 95% CI 1.05, 1.07). CONCLUSIONS Our study supports our hypothesis that patients who underwent THA at hospitals with higher safety net burden have poorer outcomes than patients at hospitals with lower safety net burden.
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Affiliation(s)
- Melvin La
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York City, New York, USA
| | - Virginia Tangel
- Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Soham Gupta
- Center for Perioperative Outcomes, Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Tiffany Tedore
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York City, New York, USA
| | - Robert S White
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York City, New York, USA
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