title: Insurance status affects postoperative morbidity and complication rate after shoulder arthroplasty.
abstract: BACKGROUND
  Shoulder arthroplasty is an effective procedure for managing patients with shoulder pain secondary to end-stage arthritis. Insurance status has been shown to be a predictor of patient morbidity and mortality. The current study evaluated the effect of patient insurance status on perioperative outcomes after shoulder replacement surgery.
  
  
  METHODS
  Data between 2004 and 2011 were obtained from the Nationwide Inpatient Sample. Analysis included patients undergoing shoulder arthroplasty (partial, total, and reverse) procedures determined by International Classification of Disease, 9th Revision procedure codes. The primary outcome was medical and surgical complications occurring during the same hospitalization, with secondary analyses of mortality and hospital charges. Additional analyses using the coarsened exact matching algorithm were performed to assess the influence of insurance type in predicting outcomes.
  
  
  RESULTS
  A data inquiry identified 103,290 shoulder replacement patients (68,578 Medicare, 27,159 private insurance, 3544 Medicaid/uninsured, 4009 other). The overall complication rate was 17.2% (n = 17,810) and the mortality rate was 0.20% (n = 208). Medicare and Medicaid/uninsured patients had a significantly higher rate of medical, surgical, and overall complications compared with private insurance using the controlled match data. Multivariate regression analysis found that having private insurance was associated with fewer overall medical complications.
  
  
  CONCLUSIONS
  Private insurance payer status is associated with a lower risk of perioperative medical and surgical complications compared with an age- and sex-matched Medicare and Medicaid/uninsured payer status. Mortality was not statistically associated with payer status. Primary insurance payer status should be considered as an independent risk factor during preoperative risk stratification for shoulder arthroplasty procedures.
authors.affiliation: Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: Xinning.li@gmail.com.
authors.forename: Xinning
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Veltre
authors.affiliation: Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cusano
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Yi
authors.affiliation: Department of Orthopaedic Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Sing
authors.affiliation: Department of Epidemiology and Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Joel J
authors.initials: JJ
authors.lastname: Gagnier
authors.affiliation: Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Josef K
authors.initials: JK
authors.lastname: Eichinger
authors.affiliation: Department of Orthopaedic Surgery, New England Baptist Hospital, Waltham, MA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jawa
authors.affiliation: Department of Epidemiology and Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
mesh_terms: D000328:Adult; D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: insurance status; medical complications; reverse shoulder arthroplasty; shoulder arthritis; shoulder arthroplasty; surgical complications