Socioeconomic factors including patient income, education level and health insurance influence post-operative secondary surgery and hospitalization rates following hip arthroscopy

Juan Serna; Cameron Nosrat; Kevin Wang; Favian Su; Stephanie E Wong; Alan L Zhang

doi:10.1016/j.arthro.2024.04.032

Socioeconomic factors including patient income, education level and health insurance influence post-operative secondary surgery and hospitalization rates following hip arthroscopy

Arthroscopy. 2024 May 10:S0749-8063(24)00338-4. doi: 10.1016/j.arthro.2024.04.032. Online ahead of print.

Authors

Juan Serna¹, Cameron Nosrat¹, Kevin Wang¹, Favian Su¹, Stephanie E Wong¹, Alan L Zhang²

Affiliations

¹ Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
² Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A. Electronic address: alan.zhang@ucsf.edu.

PMID: 38735415
DOI: 10.1016/j.arthro.2024.04.032

Abstract

Purpose: To evaluate a large cross-sectional sample of patients utilizing administrative database records, and analyze the effects of income, insurance type, and education level on outcomes after hip arthroscopy, including 2-year revision surgery, conversion to total hip arthroplasty (THA) and 90-day hospitalizations.

Methods: Current Procedural Terminology codes were used to query the PearlDiver^TM Mariner database from October 2015 to January 2020 for patients undergoing hip arthroscopy with minimum 2-year follow-up. Patients were categorized by mean family income in their zip code of residence (MFIR), health insurance type, and educational attainment in their zip code of residence (EAR). 2-year revision arthroscopy, conversion to THA and 90-day hospital readmissions or emergency department (ED) visits were analyzed along socioeconomic strata.

Results: Multivariate analysis of 33,326 patients revealed that patients with MFIR between $30,000-$70,000 had lower odds of 2-year revision arthroscopy [OR = 0.63, p < 0.001], THA conversion [OR= 0.76, p= 0.050], and 90-day readmission [OR= 0.53, p= 0.007] compared to MFIR >$100,000. Compared to patients with commercial insurance, patients with Medicare had lower odds of revision arthroscopy [OR= 0.60, p= 0.035] and THA conversion [OR= 0.46, p< 0.001], but greater odds of 90-day readmission [OR= 1.74, p= 0.007]. Patients with Medicaid had higher odds of 90-day ED visits [OR= 1.84, p< 0.001]. Patients with low EAR had higher odds of revision arthroscopy [OR= 1.42, p= 0.005] and THA conversion [OR= 1.58, p= 0.002] compared to those with high EAR.

Conclusion: Following hip arthroscopy, patients residing in areas with lower mean family income were less likely to undergo reoperations and readmissions. Medicare patients showed lower reoperation but higher readmission odds, while Medicaid patients showed higher odds of ED visits. Additionally, higher educational attainment in the zip code of residence is protective against future reoperation.

Level of evidence: Level III. Retrospective Case Series.