@article {Singhjrheum.190287, author = {Jasvinder A. Singh and John D. Cleveland}, title = {Insurance Payer Type and Patient Income Are Associated with Outcomes after Total Shoulder Arthroplasty}, elocation-id = {jrheum.190287}, year = {2019}, doi = {10.3899/jrheum.190287}, publisher = {The Journal of Rheumatology}, abstract = {Objective To assess the independent association of insurance and patient income with total shoulder arthroplasty (TSA) outcomes. Methods We used the 1998{\textendash}2014 US National Inpatient Sample. We used multivariable-adjusted logistic regression to examine whether insurance type and the patient{\textquoteright}s median household income (based on postal code) were independently associated with healthcare use (discharge destination, hospital stay duration, total hospital charges) and in-hospital complications post-TSA based on the diagnostic codes (fracture, infection, transfusion, or revision surgery). We calculated the OR and 95\% CI. Results Among the 349,046 projected TSA hospitalizations, the mean age was 68.6 years, 54\% were female, and 73\% white. Compared to private insurance, Medicaid and Medicare (government insurance) users were associated with significantly higher adjusted OR (95\% CI) of (1) discharge to a rehabilitation facility, 2.16 (1.72{\textendash}2.70) and 2.27 (2.04{\textendash}2.52); (2) hospital stay \> 2 days, 1.65 (1.45{\textendash}1.87) and 1.60 (1.52{\textendash}1.69); and (3) transfusion, 1.35 (1.05{\textendash}1.75) and 1.39 (1.24{\textendash}1.56), respectively. Medicaid was associated with a higher risk of fracture [1.74 (1.07{\textendash}2.84)] and Medicare user with a higher risk of infection [2.63 (1.24{\textendash}5.57)]; neither were associated with revision. Compared to the highest income quartile, the lowest income quartile was significantly associated with (OR, 95\% CI): (1) discharge to a rehabilitation facility (0.89, 0.83 {\textendash}0.96); (2) hospital stay \> 2 days (0.84, 0.80{\textendash}0.89); (3) hospital charges above the median (1.19, 1.14{\textendash}1.25); (4) transfusion (0.73, 0.66{\textendash}0.81); and (5) revision (0.49, 0.30{\textendash}0.80), but not infection or fracture. Conclusion This information can help to risk-stratify patients post-TSA. Future assessments of modifiable mediators of these complications are needed.}, issn = {0315-162X}, URL = {https://www.jrheum.org/content/early/2019/10/08/jrheum.190287}, eprint = {https://www.jrheum.org/content/early/2019/10/08/jrheum.190287.full.pdf}, journal = {The Journal of Rheumatology} }