Insurance Payer Type Affects Outcomes after Revision Total Joint Arthroplasty: A Matched Cohort Analysis

Document Type : RESEARCH PAPER


Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA


Background: The aim of this study is to evaluate the potential effects of insurance payer type on the postoperative 
outcomes following revision TJA. 
Methods: A single-institution database was utilized to identify 4,302 consecutive revision THA and TKA. Patient 
demographics and indications for revision were collected and compared based on patient insurance payer type: (1) 
Medicaid, (2) Medicare, and (3) private. Propensity score matching and, subsequent, multivariate regression analyses 
were applied to control for baseline differences between payer groups. Outcomes of interest were rates of complications 
occurring perioperatively and 90 days post-discharge.
Results: After propensity-score-based matching, a total of 2,328 patients remained for further multivariate regression 
analyses (300 [12.9%] Medicaid, 1022 [43.9%] Medicare, 1006 [43.2%] private). Compared to privately insured patients, 
Medicaid and Medicare patients had 71% (P<0.01) and 53% (P=0.03) increased odds, respectively, for developing an 
in-hospital complication. At 90 days post-discharge, compared to privately insured patients, Medicaid and Medicare 
patients had 88% and 43% odds, respectively, for developing overall major complications.
Conclusion: Our propensity-score-matched cohort study found that, compared to privately insured patients, patients 
with government-sponsored insurance were at an increased risk for developing both major or minor complications 
perioperatively and at 90-days post-discharge for revision TJA. This suggests that insurance payer type is an 
independent risk factor for poor outcomes following revision TJA.
Level of evidence: III


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