The effect of lower socioeconomic status insurance on outcomes after primary shoulder arthroplasty

Abstract

Background: Patient-reported outcomes (PROs) are becoming increasingly important to define successful outcomes. With the potential transition toward quality-based reimbursement, identifying risk factors for poor surgical outcomes becomes increasingly important. This study compared functional and PROs of primary shoulder arthroplasty in patients aged younger than 65 years with lower socioeconomic insurance compared with those with private insurance.

Methods: A retrospective review of all primary shoulder arthroplasties in patients aged younger than 65 was performed at a single institution. Patients were stratified according to insurance type (private vs. Medicare/Medicaid) with 2-year minimum follow-up. Preoperative, postoperative, and improvements in range of motion, visual analog scale (VAS) pain, and PROs were compared.

Results: We evaluated 143 shoulders (64 Medicare/Medicaid, 79 private insurance). Age, race, diagnosis, and type of arthroplasty were similar between groups. Patients with Medicare/Medicaid insurance demonstrated worse PROs before and after surgery, despite similar range of motion at both assessments. Despite poorer PROs postoperatively, both groups demonstrated similar improvements after surgery. Complications and reoperation were more common in the socioeconomically disadvantaged group (14% vs. 9%, P = .3; 11% vs. 6%, P = .2, respectively).

Discussion: Medicaid and Medicare patients aged younger than 65 years undergoing shoulder arthroplasty demonstrate poorer preoperative and postoperative PRO measures compared with similar patients with private insurance. However, both groups demonstrate similar improvements in scores from baseline.

Keywords: Shoulder arthroplasty; economically disadvantaged; insurance; low income; medicaid; socioeconomic.