Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

BACKGROUND

Patients with public insurance often face barriers to obtaining prompt orthopaedic care. For patients with recurrent traumatic anterior shoulder instability, delayed care may be associated with increasing bone loss and subsequently more extensive surgical procedures.

PURPOSE/HYPOTHESIS

The purpose of this study was to evaluate whether differences exist in patients undergoing treatment for shoulder instability between those with Medicaid versus non-Medicaid insurance. We hypothesized that at the time of surgery, Medicaid patients would have experienced greater delays in care, would have a more extensive history of instability, would have more bone loss, and would require more extensive surgical procedures than other patients.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Patients were identified who underwent surgical stabilization for traumatic anterior shoulder instability between January 1, 2011, and December 1, 2015, at a single sports medicine practice. Clinic, billing, and operative records were reviewed for each patient to determine age, sex, insurance type, total number of instability episodes, time from first instability episode to surgery, intraoperative findings, and procedure performed. Glenoid bone loss was quantified by use of preoperative imaging studies.

RESULTS

During this time period, 206 patients (55 Medicaid, 131 private insurance, 11 Tricare, 9 workers' compensation) underwent surgical stabilization for traumatic anterior shoulder instability. Average wait time from initial injury to surgery was 1640 days (95% CI, 1155-2125 days) for Medicaid patients compared with 1237 days (95% CI, 834-1639 days) for others (

CONCLUSION

Among patients undergoing surgery for traumatic anterior shoulder instability, patients with Medicaid had significantly more delayed care. Correspondingly, they reported a more extensive history of instability, were more likely to have severe bone loss, and required more invasive stabilization procedures.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: A.A.W. has received educational support from Smith & Nephew and hospitality payments from Axogen. R.A.A. has received grants from Arthrex and Depuy Mitek and consulting fees from Biomet, Biorez, and DePuy. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.