Objectives:
The impact of social determinants of health including insurance coverage on outcomes for patients undergoing primary hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS) and labral tears is poorly characterized. The purposes of this study were: (1) To evaluate the effects of Medicaid insurance coverage on 90 day-complications, emergency department (ED) visits, and five-year revision rates following primary hip arthroscopy performed for FAIS and/or labral tears using a large national database and (2) To compare these outcomes with a matched control group of commercially-insured patients undergoing primary hip arthroscopy.
Methods
The PearlDiver Mariner151 database was used to identify patients with International Classification of Diseases (ICD)-10 diagnosis codes for FAI and/or labral tear who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021. Those with concomitant ICD-10 codes for infection, neoplasm, or fracture were excluded, as were patients with a history of prior hip arthroscopy or total hip arthroplasty (THA), or age >70 years. Patients with Medicaid were matched to a control group of commercially-insured patients at a 1:4 ratio by age, sex, body mass index (BMI), and Elixhauser Comorbidity Index (ECI) score. Rates of 90-day complications and 30-day ED visits were assessed. Five-year rates of revision surgery—secondary hip arthroscopy or conversion to THA—were compared between cohorts by Kaplan-Meier analysis.
Results
A total of 2,033 Medicaid patients were matched at 1:4 with 8,056 commercially-insured patients. Rates of adverse events were low; however, Medicaid patients were significantly more likely than commercially-insured patients to experience any 90-day complication (2.12% vs. 1.43%; OR=1.2, P=0.02). Medicaid patients also experienced more 30-day ED visits than commercially-insured patients (8.61% vs. 4.28%). On multivariate logistic regression, significant risks factors for 30-day ED visits included age, sex, BMI, and ECI; however, Medicaid was the strongest risk factor for 30-day ED visits, with an odd ratios of 2.02 relative to commercial insurance (P<0.001). There was no significant difference in rate of five-year revision surgery for Medicaid versus commercially-insured patients (6.1% vs 6.0%; P=0.60).
Conclusion
In this large national database study, Medicaid patients undergoing primary hip arthroscopy demonstrated significantly greater odds of experiencing 90-day postoperative complications and 30-day ED visits compared to a matched cohort of commercially-insured patients. Despite this, Medicaid patients had a low five-year rate of revision surgery which was similar to that of commercially-insured patients. These findings suggest that social determinants of health may affect short-term outcomes in patients undergoing primary hip arthroscopy but that excellent longer-term outcomes are possible.