title: Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.
abstract: BACKGROUND
  Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF).
  
  
  METHODS
  The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012. Primary outcomes included treatment type, surgical fixation method, in-hospital complications, mean length of stay, and mean total charges for Medicaid patients vs. a matched privately insured cohort. In an effort to minimize confounding variables, each Medicaid patient was matched to a privately insured patient on the basis of gender, race, year of procedure, and age.
  
  
  RESULTS
  Of the 678,831 patients treated with PHF, 4.9% (33,263) had Medicaid as the primary payer during the 10-year period. Medicaid patients were found to have a significantly higher risk (P < .05) of postoperative in-hospital complications, including postoperative infection (odds ratio [OR], 2.00 [1.37-2.93]), wound complications (OR, 1.69 [1.04-2.75]), and acute respiratory distress syndrome (OR, 1.34 [1.15-1.59]).
  
  
  CONCLUSIONS
  Medicaid patients have a significantly higher risk for certain postoperative hospital complications and consume more resources after treatment for PHFs. Additional work is needed to understand the optimal treatment type for Medicaid patients and to understand the complex interplay between socioeconomic status and outcomes to ensure appropriate resource allocation and risk stratification.
authors.affiliation: Beaumont Health Department of Orthopaedic Surgery, Taylor, MI, USA. Electronic address: sabes001@gmail.com.
authors.forename: Vani J
authors.initials: VJ
authors.lastname: Sabesan
authors.affiliation: Beaumont Health Department of Orthopaedic Surgery, Taylor, MI, USA.
authors.forename: Graysen
authors.initials: G
authors.lastname: Petersen-Fitts
authors.affiliation: Beaumont Health Department of Orthopaedic Surgery, Taylor, MI, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lombardo
authors.affiliation: Beaumont Health Department of Orthopaedic Surgery, Taylor, MI, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Briggs
authors.affiliation: Department of Orthopaedic Surgery, Wayne State University School of Medicine, Taylor, MI, USA.
authors.forename: James
authors.initials: J
authors.lastname: Whaley
mesh_terms: D000328:Adult; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Medicaid; fracture; orthopedic trauma; outcomes; payer status; proximal humerus; resource utilization