Abstract
Periprosthetic joint infection (PJI) is one of the most severe complications following
total hip arthroplasty (THA), and identifying factors associated with PJI is vital
for preoperative risk stratification. The aim of this study was to compare risk of
PJI after THA across insurance payers using a statewide health data registry. A retrospective
review was conducted querying the New York Statewide Planning and Research Cooperative
System for all patients undergoing elective unilateral primary THA using International
Classification of Diseases (ICD)-9 and ICD-10 procedure codes. Patients were stratified
into groups based on their insurance provider as private payer, Medicare, Medicaid,
or worker's compensation. Demographics, hospital clinical data, complications, PJI
rates, and mortality rates were collected. PJI rates were significantly different
between groups at both 3 (p < 0.001) and 12 months (p < 0.001) postoperatively, highest at both time points in the Medicaid group (3 months:
1.3%; 12 months: 1.8%). Log-rank test demonstrated increased cumulative PJI rates
in the worker's compensation and Medicaid groups up to 108 months postoperatively
(p < 0.001). Multivariate Cox proportional hazard regression, adjusted for demographics,
found that Medicaid insurance was associated with 1.4 times increased risk for PJI
relative to Medicare (hazard ratio:1.39; 95% confidence interval [1.19, 1.62]; p < 0.001). These results suggest patients undergoing THA covered by Medicaid are at
increased risk for PJI compared with patients covered by other insurance payers. Surgeons
should recognize this patient population is at an increased risk for PJI, and compensation
policies for treating patients covered by Medicaid should reflect the increased complication
rate associated with this population.
Keywords
insurance - periprosthetic joint infection - total hip arthroplasty - Medicaid
