The Effect of Patient Point of Entry, Medicaid Status on THA Outcomes

Studies have observed a correlation between Medicaid status and increased risk for postoperative complications following total hip arthroplasty (THA), but without controlling for the surgeon’s practice or patient care setting. A study assessed the correlation between patient point of entry and Medicaid status and quality outcomes and discharge disposition after THA.

The researchers retrospectively reviewed their institution’s electronic medical record for primary unilateral THAs performed between January 2016 and January 2018, stratifying patients into two groups: Medicaid or non-Medicaid. Patients treated by surgeons with at least 10 Medicaid and 10 non-Medicaid patients were included. Final analysis included 426 hips in 403 patients: 114 Medicaid and 312 non-Medicaid patients. The patient population was 56.33% female, with a mean age of 60.85 years, mean body mass index of 29.14 kg/m², and average length of follow-up of 343.73 days.

The mean age was significantly lower in the Medicaid group than the non-Medicaid group (54.68 years vs. 63.10 years). Medicaid patients were more likely to be black (27.19% vs. 13.46%) or “other” race (26.32% vs. 12.82%) and be a current smoker (19.30% vs. 9.29%). When adjusting for patient risk factors, a significant correlation was observed between Medicaid and length of stay (rate ratio, 1.129; 95% confidence interval [CI], 1.048-1.216; P=0.001) and facility discharge (odds ratio, 2.010; 95% CI, 1.398-2.890; P<0.001). Medicaid did not affect surgical time. No significant between-group differences were observed in 30- or 90-day readmission, 30- or 90-day infections, or 90-day mortality.

“These results indicate that clinically similar outcomes can be achieved for Medicaid patients; however, further work is needed on maximizing social support and preoperative patient education with a focus on successful home discharge,” the authors concluded.