Medicaid Patients Have Similar Functional Patient Outcomes but Lower Mental Health Scores Than Patients With Private Insurance Following Rotator Cuff Repair

Abstract

Purpose

To determine whether patients insured through Medicaid exhibit differences in patient-reported outcomes, functional measurements, reinjury, and reoperation metrics after primary rotator cuff repair compared with patients insured with private insurance.

Methods

All skeletally mature patients insured through Medicaid who had undergone a primary rotator cuff repair from January 2014 to July 2023 were identified and compared with a matched cohort of patients with private insurance. Patients were excluded if they were undergoing a revision procedure, had a history of shoulder infection, did not have completed medical records or baseline patient-reported outcome measures, or were lost to follow-up before 1 year postoperatively. Patients were provided questionnaires containing the American Shoulder and Elbow Surgeons (ASES) score, the Veterans RAND 12-Item Health Survey (VR-12), and reinjury and reoperation metrics. Physical therapy (PT) and clinic notes were also reviewed to determine the number of PT visits attended, number of PT visits missed, distance from patients’ home address to the PT facility, range of motion, and comorbidities.

Results

A total of 16 patients insured through Medicaid and 16 insured through private insurance were enrolled in this study. There was no difference in average follow-up time between the 2 groups (31.1 vs 38.4 months; P = .391). The 2 groups showed no differences in age, body mass index, sex, smoking status, or other comorbidities, including diabetes, hypertension, and depression. The Medicaid group had a significantly lower preoperative ASES (29.86 vs 46.28; P = .008). Patients insured through Medicaid also had a significantly lower postoperative VR-12 Mental Score (38.20 vs 53.40; P = .013). There was no significant difference in preoperative or postoperative forward flexion or external rotation between the 2 groups. The average distance from home to PT facility, the number of postoperative PT sessions attended and missed, and reinjury and reoperation rates were also similar between groups. Both groups attained the minimal clinically important difference for ASES and VR-12 Physical but not VR-12 Mental.

Conclusions

Despite Medicaid patients having a lower ASES preoperatively, they showed no difference in functional outcomes compared to patients with private insurance at final follow-up. However, patients with Medicaid had a significantly lower postoperative VR-12 Mental score, which requires further exploration.

Level of Evidence

Level III, retrospective comparative study.