The association between the insurance provider and rates of surgical stabilization for the treatment of glenohumeral dislocation: A nationwide retrospective analysis

Abstract

Background

Public insurance has recently been associated with a decreased likelihood of receiving surgery to address glenohumeral instability in several state-specific analyses. The purpose of this study is to expand this literature and analyze this association in a nationwide sample.

Methods

A national insurance claims database was used to identify shoulder dislocations between 2011 through 2019. Patients were stratified by insurance status (Medicaid or commercial) and age (5–24, 25–44, and 45–64 years). Billing codes were used to identify surgical stabilization and recurrent dislocations. Multivariable logistic regression was performed to compare the likelihood of surgical stabilization and recurrent instability.

Results

Of 292 672 patients, those with Medicaid were 48% less likely to receive surgery within 30 days, 32% less likely within 1 year, and 31% less likely within 2 years of their dislocation. When compared to those with commercial insurance, patients aged 45–64 years with Medicaid were the least likely to undergo surgery to address their shoulder instability (OR = 0.51, 95% CI, 0.40–0.65, p < 0.001).

Conclusion

Patients with Medicaid insurance are less likely to have their glenohumeral dislocation managed surgically, highlighting the limited healthcare access of patients with Medicaid insurance.