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Increased length of stay following total joint arthroplasty based on insurance type

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Increased length of stay after total joint arthroplasty has been shown to be a risk factor for peri-operative complications. The purpose of this study was to determine if Medicaid insurance would be a risk factor for increased length of stay after total joint arthroplasty.

Methods

We retrospectively reviewed a single surgeon’s practice of 428 total hip and total knee arthroplasties who had insurance status of Medicaid, Medicare, Private or none. After exclusion criteria there were 400 patients. Patients with insurance status of Medicaid, Medicare or Private were then compared based on length of stay ≤ 2 days and length of stay > 2 days and then further analyzed using demographic, operative data, and total length of stay.

Results

Medicaid patients had an increased length of stay compared to patients with Medicare or Private insurance [1.98 days versus 1.73 days, p = .037, 95% confidence intervals (1.78–2.18) and (1.61–1.85), respectively]. The greatest predictor of a less than two-night stay post-operatively was private insurance status (p = 0.001). Medicaid patients had a higher incidence of prescribed narcotic use pre-operatively (p = 0.013). Although not significant, a trend was noted in the Medicaid population with higher incidence of smoking (p = 0.094) and illicit drug abuse (p = 0.099) pre-operatively in this sample subset.

Conclusions

Patients with Medicaid insurance undergoing total joint arthroplasty have increased length of stay compared to patients with Medicare or Private insurance and have higher incidence of pre-operative narcotic use.

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References

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision total knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am 89(4):780–785. https://doi.org/10.2106/JBJS.F.00222

    Article  Google Scholar 

  2. New Medicare Data Available to Increase Transparency on Hospital Utilization | CMS.” Home - Centers for Medicare & Medicaid Services | CMS, CMS, 1 June 2015. https://www.cms.gov/newsroom/fact-sheets/new-medicare-data-available-increase-transparency-hospital-utilization

  3. Services CFMAM (2015) Medicare program; Comprehensive care for joint replacement payment model for acute care hospitals Furnishing lower extremity joint replacement services; Proposed Rule Vol. 80. 7/14/2015 ed. Fed Registrar 2015:41197

  4. Bozic KJ, Wagie A, Naessens JM, Berry DJ, Rubash HE (2006) Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty. J Arthroplasty 21(6 Suppl 2):151–156. https://doi.org/10.1016/j.arth.2006.04.015

    Article  PubMed  Google Scholar 

  5. Bradley CJ, Dahman B, Bear HD (2012) Insurance and inpatient care: differences in length of stay and costs between surgically treated cancer patients. Cancer 118(20):5084–5091. https://doi.org/10.1002/cncr.27508

    Article  PubMed  Google Scholar 

  6. Courtney PM, Edmiston T, Batko B, Levine BR (2017) Can bundled payments be successful in the Medicaid population for primary joint arthroplasty? J Arthroplasty 32(11):3263–3267. https://doi.org/10.1016/j.arth.2017.05.035

    Article  PubMed  Google Scholar 

  7. Dall GF, Ohly NE, Ballantyne JA, Brenkel IJ (2009) The influence of pre-operative factors on the length of inpatient stay following primary total hip replacement for osteoarthritis. J Bone Jt Surg Br 91(4):434–440. https://doi.org/10.1302/0301-620X.91B4.21505

    Article  CAS  Google Scholar 

  8. Inneh IA, Iorio R, Slover JD, Bosco JA (2015) Role of sociodemographic, co-morbid and intraoperative factors in length of stay following primary total hip arthroplasty. J Arthropolasty 30(12):2092–2097. https://doi.org/10.1016/j.arth.2015.06.054

    Article  Google Scholar 

  9. Inneh IA (2015) The combined influence of sociodemographic, preoperative comorbid and intraoperative factors on longer length of stay after elective primary total knee arthroplasty. J Arthroplasty 30(11):1883–1886. https://doi.org/10.1016/j.arth.2015.05.032

    Article  PubMed  Google Scholar 

  10. O’Malley NT, Fleming FJ, Gunzler DD, Messing SP, Kates SL (2012) Factors independently associated with complications and length of stay after hip arthroplasty: analysis of the National Surgical Quality Improvement Program. J Arthroplasty 27(10):1832–1837. https://doi.org/10.1016/j.arth.2012.04.025

    Article  PubMed  Google Scholar 

  11. Shau D, Shenvi N, Easley K, Smith M, Guild G (2018) Medicaid is associated with increased readmission and resource utilization after primary total knee arthroplasty: a propensity score matched analysis. Arthroplasty Today 4(3):354–358

    Article  PubMed  PubMed Central  Google Scholar 

  12. Waits SA, Reames BN, Sheetz KH, Englesbe MJ, Campbell DA Jr (2014) Anticipating the effects of Medicaid expansion on surgical care. JAMA Surg 149(7):745–747. https://doi.org/10.1001/jamasurg.2014.222

    Article  PubMed  PubMed Central  Google Scholar 

  13. Agency for Healthcare Research and Quality (2014) Overview of hospital stays in the United States, 2012. Retrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf. Accessed 24 Mar 2020

  14. Rozell JC, Courtney PM, Dattilo JR, Wu CH, Lee GC (2017) Preoperative opiate use independently predicts narcotic consumption and complications after total joint arthroplasty. J Arthroplasty 32(9):2658–2662. https://doi.org/10.1016/j.arth.2017.04.002 (Epub 2017 Apr 12 PMID: 28478186)

    Article  PubMed  Google Scholar 

  15. Boylan MR, Riesgo AM, Chu A, Paulino CB, Feldman DS (2019) Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery. J Pediatr Orthop B 28(1):27–31. https://doi.org/10.1097/BPB.0000000000000543

    Article  PubMed  Google Scholar 

  16. Lovald ST, Ong KL, Malkani AL, Lau EC, Schmier JK, Kurtz SM, Manley MT (2014) Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 29:510–515. https://doi.org/10.1016/j.arth.2013.07.020

    Article  PubMed  Google Scholar 

  17. Grosso MJ, Neuwirth AL, Boddapati V, Shah RP, Cooper HJ, Geller JA (2019) Decreasing length of hospital stay and postoperative complications after primary total hip arthroplasty: a decade analysis from 2006 to 2016. J Arthroplasty 34(3):422–425. https://doi.org/10.1016/j.arth.2018.11.005

    Article  PubMed  Google Scholar 

  18. Williams J, Kester B, Bosco JA, Slover JD, Iorio R, Schwarkopf R (2017) The association between hospital length of stay and 90-day readmission risk within a total joint arthroplasty bundled payment initiative. J Arthroplasty 32(3):714–718. https://doi.org/10.1016/j.arth.2016.09.005

    Article  PubMed  Google Scholar 

  19. Dulworth S, Pyenson B (2004) Healthcare-associated infections and length of hospital stay in the medicare population. Am J Med Qual 19(3):121–127. https://doi.org/10.1177/106286060401900305

    Article  PubMed  Google Scholar 

  20. Amin AN, Varker H, Princic N, Lin J, Thompson S, Johnston S (2012) Duration of venous thromboembolism risk across a continuum in medically ill patients. J Hosp Med 7(3):231–238. https://doi.org/10.1002/jhm.1002

    Article  PubMed  Google Scholar 

  21. Slostad JA, Slostad B, Crusan D, Petterson T, Bailey K, Ashrani AA, Heit JA (2018) Impact of length of stay on hospital-associated venous thromboembolism (VTE). Blood 132(Supplement 1):1225. https://doi.org/10.1182/blood-2018-99-117177

    Article  Google Scholar 

  22. Sibia US, Waite KA, Callanan MA, Park AE, King PJ, MacDonald JH (2017) Do shorter lengths of stay increase readmissions after total joint replacements? Arthroplast Today 3(1):51–55. https://doi.org/10.1016/j.artd.2016.05.001

    Article  PubMed  Google Scholar 

  23. Sloan M, Premkumar A, Sheth NP (2018) Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Jt Surg Am 100(17):1455–1460. https://doi.org/10.2106/JBJS.17.01617

    Article  Google Scholar 

  24. Three Day Payment Window (2020) CMS, 11 Feb 2020, www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Three_Day_Payment_Window

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Funding

No author(s) listed have received grant support or research funding for this article. There are no proprietary interests for any materials described in this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, OhioHealth Doctors Hospital, 5100 West Broad Street, Suite 500, Columbus, OH, 43228, USA

    Brian W. Skura, Craig Goubeaux, Braden J. Passias, Hayden B. Schuette, Anthony J. Melaragno, Matthew T. Glazier & William Burgette

  2. Academic Research Services, OhioHealth Research Institute, 3545 Olentangy River Road, Suite 301, Columbus, OH, 43214, USA

    Mallory Faherty

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  1. Brian W. Skura
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Correspondence to Brian W. Skura.

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Skura, B.W., Goubeaux, C., Passias, B.J. et al. Increased length of stay following total joint arthroplasty based on insurance type. Arch Orthop Trauma Surg 143, 2273–2281 (2023). https://doi.org/10.1007/s00402-022-04417-1

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  • DOI: https://doi.org/10.1007/s00402-022-04417-1

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