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Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York

To confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements. Retrospective cohort study. Administrative database study using 2007–2011 data from California, Florida, and New York from the State Inpa... Full description

Journal Title: Journal of clinical anesthesia 2017-12, Vol.43, p.24-32
Main Author: Xu, Hannah F
Other Authors: White, Robert S , Sastow, Dahniel L , Andreae, Michael H , Gaber-Baylis, Licia K , Turnbull, Zachary A
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: United States: Elsevier Inc
ID: ISSN: 0952-8180
Link: https://www.ncbi.nlm.nih.gov/pubmed/28972923
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5698092
title: Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York
format: Article
creator:
  • Xu, Hannah F
  • White, Robert S
  • Sastow, Dahniel L
  • Andreae, Michael H
  • Gaber-Baylis, Licia K
  • Turnbull, Zachary A
subjects:
  • administrative database research
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics
  • Analysis
  • Anesthesia
  • Arthroplasty, Replacement, Hip - adverse effects
  • Arthroplasty, Replacement, Hip - economics
  • Article
  • Bias
  • Census of Population
  • Codes
  • Comorbidity
  • Confidence intervals
  • Databases
  • Discrimination in medical care
  • Female
  • Health care
  • Health Care Costs - statistics & numerical data
  • Health care disparities
  • Health care policy
  • Health disparities
  • Health insurance
  • Healthcare Disparities - economics
  • Healthcare Disparities - statistics & numerical data
  • Hospital Mortality
  • Hospitalization - economics
  • Hospitalization - statistics & numerical data
  • Hospitals
  • Humans
  • Hypotheses
  • Insurance
  • Joint surgery
  • Male
  • Medicaid
  • Medicaid - statistics & numerical data
  • Medical care
  • Medical care, Cost of
  • Medical research
  • Medically Uninsured - statistics & numerical data
  • Medicare - statistics & numerical data
  • Medicine, Experimental
  • Middle Aged
  • Mortality
  • Pain
  • Patient Acceptance of Health Care - statistics & numerical data
  • Patient Protection & Affordable Care Act 2010-US
  • Patients
  • Pediatrics
  • Perioperative Period
  • Postoperative Complications - economics
  • Postoperative Complications - epidemiology
  • Postoperative Complications - etiology
  • primary payer status
  • Public health
  • Quality management
  • Registries - statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Social Determinants of Health - economics
  • Social Determinants of Health - statistics & numerical data
  • Socioeconomic Factors
  • Studies
  • Surgery
  • Surgical outcomes
  • total hip replacement
  • Uninsured people
  • United States - epidemiology
  • Variance analysis
ispartof: Journal of clinical anesthesia, 2017-12, Vol.43, p.24-32
description: To confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements. Retrospective cohort study. Administrative database study using 2007–2011 data from California, Florida, and New York from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. 295,572 patients age≥18years old who underwent total hip replacement with non-missing insurance data were collected, using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses and procedures code (ICD-9-CM code 81.51). Patients underwent total hip replacement. Patients were cohorted by insurance type as either Medicare, Medicaid, Uninsured, Other, and Private Insurance. Demographic characteristics and comorbidities were compared. Unadjusted rates of in-hospital mortality, postoperative complications, LOS, 30-day, and 90-day readmission status were compared. Adjusted odds ratios were calculated for our outcomes using multivariate linear and logistic regression models fitted to our data. Medicaid patients incurred a 125% increase in the odds of in-hospital mortality compared to those with Private Insurance (OR 2.25, 99% CI 1.01–5.01). Medicaid payer status was associated with the highest statistically significant adjusted odds of mortality, any complication (OR, 1.26), cardiovascular complications (OR, 1.37), and infectious complications (OR, 1.66) when compared with Private Insurance. Medicaid patients had the highest statistically significant adjusted odds of 30-day (OR, 1.63) and 90-day readmission (OR, 1.58) and the longest adjusted LOS. We found higher unadjusted rates and risk adjusted odds ratios of postoperative mortality, morbidity, LOS, and readmissions for patients with Medicaid insurance as compared to patients with Private Insurance. Our study shows that primary payer status serves as a predictor of perioperative risks and that primary payer status should be viewed as a peri-operative risk factor. •Medicaid patients had increased odds of postoperative complications after total hip replacement.•Medicaid insurance status may serve as a predictor for increased postoperative risks.•Differences in outcomes may reflect broader disparities in the health care system.
language: eng
source:
identifier: ISSN: 0952-8180
fulltext: no_fulltext
issn:
  • 0952-8180
  • 1873-4529
url: Link


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creatorXu, Hannah F ; White, Robert S ; Sastow, Dahniel L ; Andreae, Michael H ; Gaber-Baylis, Licia K ; Turnbull, Zachary A
creatorcontribXu, Hannah F ; White, Robert S ; Sastow, Dahniel L ; Andreae, Michael H ; Gaber-Baylis, Licia K ; Turnbull, Zachary A
descriptionTo confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements. Retrospective cohort study. Administrative database study using 2007–2011 data from California, Florida, and New York from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. 295,572 patients age≥18years old who underwent total hip replacement with non-missing insurance data were collected, using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses and procedures code (ICD-9-CM code 81.51). Patients underwent total hip replacement. Patients were cohorted by insurance type as either Medicare, Medicaid, Uninsured, Other, and Private Insurance. Demographic characteristics and comorbidities were compared. Unadjusted rates of in-hospital mortality, postoperative complications, LOS, 30-day, and 90-day readmission status were compared. Adjusted odds ratios were calculated for our outcomes using multivariate linear and logistic regression models fitted to our data. Medicaid patients incurred a 125% increase in the odds of in-hospital mortality compared to those with Private Insurance (OR 2.25, 99% CI 1.01–5.01). Medicaid payer status was associated with the highest statistically significant adjusted odds of mortality, any complication (OR, 1.26), cardiovascular complications (OR, 1.37), and infectious complications (OR, 1.66) when compared with Private Insurance. Medicaid patients had the highest statistically significant adjusted odds of 30-day (OR, 1.63) and 90-day readmission (OR, 1.58) and the longest adjusted LOS. We found higher unadjusted rates and risk adjusted odds ratios of postoperative mortality, morbidity, LOS, and readmissions for patients with Medicaid insurance as compared to patients with Private Insurance. Our study shows that primary payer status serves as a predictor of perioperative risks and that primary payer status should be viewed as a peri-operative risk factor. •Medicaid patients had increased odds of postoperative complications after total hip replacement.•Medicaid insurance status may serve as a predictor for increased postoperative risks.•Differences in outcomes may reflect broader disparities in the health care system.
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0Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York
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descriptionTo confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements. Retrospective cohort study. Administrative database study using 2007–2011 data from California, Florida, and New York from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. 295,572 patients age≥18years old who underwent total hip replacement with non-missing insurance data were collected, using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses and procedures code (ICD-9-CM code 81.51). Patients underwent total hip replacement. Patients were cohorted by insurance type as either Medicare, Medicaid, Uninsured, Other, and Private Insurance. Demographic characteristics and comorbidities were compared. Unadjusted rates of in-hospital mortality, postoperative complications, LOS, 30-day, and 90-day readmission status were compared. Adjusted odds ratios were calculated for our outcomes using multivariate linear and logistic regression models fitted to our data. Medicaid patients incurred a 125% increase in the odds of in-hospital mortality compared to those with Private Insurance (OR 2.25, 99% CI 1.01–5.01). Medicaid payer status was associated with the highest statistically significant adjusted odds of mortality, any complication (OR, 1.26), cardiovascular complications (OR, 1.37), and infectious complications (OR, 1.66) when compared with Private Insurance. Medicaid patients had the highest statistically significant adjusted odds of 30-day (OR, 1.63) and 90-day readmission (OR, 1.58) and the longest adjusted LOS. We found higher unadjusted rates and risk adjusted odds ratios of postoperative mortality, morbidity, LOS, and readmissions for patients with Medicaid insurance as compared to patients with Private Insurance. Our study shows that primary payer status serves as a predictor of perioperative risks and that primary payer status should be viewed as a peri-operative risk factor. •Medicaid patients had increased odds of postoperative complications after total hip replacement.•Medicaid insurance status may serve as a predictor for increased postoperative risks.•Differences in outcomes may reflect broader disparities in the health care system.
subject
0administrative database research
1Adult
2Aged
3Aged, 80 and over
4Analgesics
5Analysis
6Anesthesia
7Arthroplasty, Replacement, Hip - adverse effects
8Arthroplasty, Replacement, Hip - economics
9Article
10Bias
11Census of Population
12Codes
13Comorbidity
14Confidence intervals
15Databases
16Discrimination in medical care
17Female
18Health care
19Health Care Costs - statistics & numerical data
20Health care disparities
21Health care policy
22Health disparities
23Health insurance
24Healthcare Disparities - economics
25Healthcare Disparities - statistics & numerical data
26Hospital Mortality
27Hospitalization - economics
28Hospitalization - statistics & numerical data
29Hospitals
30Humans
31Hypotheses
32Insurance
33Joint surgery
34Male
35Medicaid
36Medicaid - statistics & numerical data
37Medical care
38Medical care, Cost of
39Medical research
40Medically Uninsured - statistics & numerical data
41Medicare - statistics & numerical data
42Medicine, Experimental
43Middle Aged
44Mortality
45Pain
46Patient Acceptance of Health Care - statistics & numerical data
47Patient Protection & Affordable Care Act 2010-US
48Patients
49Pediatrics
50Perioperative Period
51Postoperative Complications - economics
52Postoperative Complications - epidemiology
53Postoperative Complications - etiology
54primary payer status
55Public health
56Quality management
57Registries - statistics & numerical data
58Retrospective Studies
59Risk Factors
60Social Determinants of Health - economics
61Social Determinants of Health - statistics & numerical data
62Socioeconomic Factors
63Studies
64Surgery
65Surgical outcomes
66total hip replacement
67Uninsured people
68United States - epidemiology
69Variance analysis
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titleMedicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York
authorXu, Hannah F ; White, Robert S ; Sastow, Dahniel L ; Andreae, Michael H ; Gaber-Baylis, Licia K ; Turnbull, Zachary A
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languageeng
creationdate2017
topic
0administrative database research
1Adult
2Aged
3Aged, 80 and over
4Analgesics
5Analysis
6Anesthesia
7Arthroplasty, Replacement, Hip - adverse effects
8Arthroplasty, Replacement, Hip - economics
9Article
10Bias
11Census of Population
12Codes
13Comorbidity
14Confidence intervals
15Databases
16Discrimination in medical care
17Female
18Health care
19Health Care Costs - statistics & numerical data
20Health care disparities
21Health care policy
22Health disparities
23Health insurance
24Healthcare Disparities - economics
25Healthcare Disparities - statistics & numerical data
26Hospital Mortality
27Hospitalization - economics
28Hospitalization - statistics & numerical data
29Hospitals
30Humans
31Hypotheses
32Insurance
33Joint surgery
34Male
35Medicaid
36Medicaid - statistics & numerical data
37Medical care
38Medical care, Cost of
39Medical research
40Medically Uninsured - statistics & numerical data
41Medicare - statistics & numerical data
42Medicine, Experimental
43Middle Aged
44Mortality
45Pain
46Patient Acceptance of Health Care - statistics & numerical data
47Patient Protection & Affordable Care Act 2010-US
48Patients
49Pediatrics
50Perioperative Period
51Postoperative Complications - economics
52Postoperative Complications - epidemiology
53Postoperative Complications - etiology
54primary payer status
55Public health
56Quality management
57Registries - statistics & numerical data
58Retrospective Studies
59Risk Factors
60Social Determinants of Health - economics
61Social Determinants of Health - statistics & numerical data
62Socioeconomic Factors
63Studies
64Surgery
65Surgical outcomes
66total hip replacement
67Uninsured people
68United States - epidemiology
69Variance analysis
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abstractTo confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements. Retrospective cohort study. Administrative database study using 2007–2011 data from California, Florida, and New York from the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. 295,572 patients age≥18years old who underwent total hip replacement with non-missing insurance data were collected, using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses and procedures code (ICD-9-CM code 81.51). Patients underwent total hip replacement. Patients were cohorted by insurance type as either Medicare, Medicaid, Uninsured, Other, and Private Insurance. Demographic characteristics and comorbidities were compared. Unadjusted rates of in-hospital mortality, postoperative complications, LOS, 30-day, and 90-day readmission status were compared. Adjusted odds ratios were calculated for our outcomes using multivariate linear and logistic regression models fitted to our data. Medicaid patients incurred a 125% increase in the odds of in-hospital mortality compared to those with Private Insurance (OR 2.25, 99% CI 1.01–5.01). Medicaid payer status was associated with the highest statistically significant adjusted odds of mortality, any complication (OR, 1.26), cardiovascular complications (OR, 1.37), and infectious complications (OR, 1.66) when compared with Private Insurance. Medicaid patients had the highest statistically significant adjusted odds of 30-day (OR, 1.63) and 90-day readmission (OR, 1.58) and the longest adjusted LOS. We found higher unadjusted rates and risk adjusted odds ratios of postoperative mortality, morbidity, LOS, and readmissions for patients with Medicaid insurance as compared to patients with Private Insurance. Our study shows that primary payer status serves as a predictor of perioperative risks and that primary payer status should be viewed as a peri-operative risk factor. •Medicaid patients had increased odds of postoperative complications after total hip replacement.•Medicaid insurance status may serve as a predictor for increased postoperative risks.•Differences in outcomes may reflect broader disparities in the health care system.
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