Does insurance coverage influence complication rates in shoulder replacement surgery? Findings from a new study published this month in the Journal of Shoulder and Elbow Surgery suggests that it may.
The study drew data from more than 100,000 shoulder replacement cases included in a national administrative database called The Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The group included 68,578 Medicare patients; 27,159 covered by private insurance; 3,544 who were either on Medicaid/uninsured and 4,009 others.
For the group overall, the medical and surgical complication rate was 17.2% and the mortality rate was 0.20%. However, the complication rate among Medicare patients undergoing shoulder replacement was 20.3%, while those in the Medicaid/uninsured group had a 16.9% rate of complications. Among privately insured patients, the complication rate was only 10.5%.
“Studies in the literature have shown that patients with Medicaid or no insurance have a higher mortality rate after penetrating trauma compared to private insured patients,” first author Xinning Li, MD, assistant professor of orthopedic surgery at Boston University School of Medicine., said in a statement announcing the study’s findings. “Patients with Medicaid also have higher medical complication rates after spine surgery. We report similar findings that patients with government-sponsored insurance are more likely to have medical and surgical complications compared to privately insured patients after shoulder replacement surgery. Thus, insurance status should be considered an independent risk factor for medical and surgical complications in patients undergoing shoulder replacement surgery.”
This study was published the same month the U.S. Food & Drug Administration (FDA) announced a Class I recall for Zimmer Biomet’s Comprehensive Reverse Shoulder System. According to the agency, the 3,662 Comprehensive Reverse Shoulder Humeral Trays (Model 115340) involved in the action had been associated with a higher-than –anticipated fracture rate.
Biomet, Inc., (acquired by Zimmer in 2015) also issued Class II recalls for Comprehensive Reverse Shoulder components in September 2010 and April 2011. Last February, the device maker agreed to pay $350,000 to settle a shoulder replacement lawsuit filed on behalf of a Colorado man who had experienced fractures of two deivces included in the 2010 recall. (Case No. 1:14-cv-02667-REB-NYW)