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J Am Acad Orthop Surg. 2018 Nov 8. doi: 10.5435/JAAOS-D-17-00635. [Epub ahead of print]

Insurance Status Affects Complication Rates After Total Hip Arthroplasty.

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From the Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA (Dr. Veltre, Dr. Sing, Dr. Smith, and Dr. Li), The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Yi), the Department of Epidemiology, Harvard T.H. Chan School of Public Health (Dr. Endo), and the Department of Epidemiology and Biostatistics, Boston University School of Public Health (Ms. Curry), Boston, MA.



Previous studies have examined the relationship between total hip arthroplasty (THA) and insurance status in small cohorts. This study evaluates the effect of patient insurance status on complications after primary elective THA using the Nationwide Inpatient Sample.


All patients undergoing primary elective THA from 1998 to 2011 were included. Patient demographics, comorbidities, and complications were collected and compared based on insurance type. Multivariable logistic regression and a matched cohort analysis were performed.


About 515,037 patients (53.7% Medicare, 40.1% private insurance, 3.9% Medicaid/uninsured, and 2.2% other) were included, who underwent elective THA. Privately insured patients had fewer medical complications (odds ratio, 0.80; P < 0.001), whereas patients with Medicaid or no insurance demonstrated no notable difference (odds ratio, 1.03; P = 0.367) compared with Medicare patients. Similar trends were found for both surgical complications and mortality, favoring lower complication rates for privately insured patients. Furthermore, patients with private insurance tend to go to higher volume hospitals for total hip replacement surgery compared to those with Medicare insurance.


Patients with government-sponsored insurance (Medicare or Medicaid) or no insurance have higher risk of medical complications, surgical complications, and mortality after primary elective THA compared with privately insured patients. Insurance status should be considered an independent risk factor for stratifying patients before THA procedures.


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