Medicaid expansion has made total hip arthroplasty (THA) more accessible to patients. Given the continuous attention on the opioid problem, researchers wanted to see if patients with Medicaid insurance had different postoperative pain and painkiller needs than privately or Medicare-insured individuals.

Adult patients who received elective THA between 2016 and 2019 were identified using a single-institution database. Patients in the Medicaid group received Medicaid insurance, but those who did not qualify for Medicaid were covered commercially or via Medicare. A subgroup analysis was performed, distinguishing private pay patients from Medicare patients.

There were a total of 5,845 instances detected, including 326 Medicaid (5.6%) and 5,519 non-Medicaid cases (94.4%). About 2,635 people in the non-Medicaid category were covered by private insurance. Medicaid patients were younger (56.1 compared to 63.28 versus 57.4 years; P<0.001, P<0.05), less likely to be White (39.1 versus 78.2 versus 76.2%; P<0.001), and more likely to be active smokers (21.6 versus 8.8 between 10.5%; P<0.001). For Medicaid patients, surgical time (113 against 96 compared to 98 minutes; P<0.001) and length of stay (2.7 versus 1.7 versus 1.4 days; P<0.001) were longer, with the lower home release (86.5% versus 91.8% between 97.2%; P<0.001). Medicaid patients had greater total opioid intake (178 morphine milligram equivalents [MMEs] compared 89 MME versus 82 MME; P<0.001) and average MME/day in the first 24 hours and 24 to 48 hours (52.3 versus 44.7 versus 44.45; P<0.001 & 73.8 versus 28.4 versus 29.8; P<0.001). Higher pain scores (2.71 vs. 2.31 vs. 2.38; P<0.001) and lower Activity Measure for Post-Acute Care scores (18.77 vs. 20.98 vs. 21.61; P<0.001) were seen in correlation with this. Higher pain ratings (2.71 compared to 2.31 versus 2.38; P<0.001) and lower Activity Measure for Post-Acute Care scores (18.77 versus 20.98 versus 21.61; P<0.001) mirrored this. Medicaid patients who presented for THA had higher postoperative pain and required more narcotics than non-Medicaid patients. It emphasized the need for preoperative counseling and optimization in this high-risk population. These individuals may benefit from multidisciplinary management to assure pain control while reducing the risk of long-term opiate usage.

When undergoing THA, Medicaid patients showed higher postoperative pain and needed more narcotics than non-Medicaid patients. It demonstrated the need for preoperative counseling and optimization in this population at risk. Multidisciplinary care may be beneficial for these individuals to manage their pain and reduce the risk of continued long-term opiate usage.

Reference: journals.lww.com/jaaos/Abstract/2022/07150/The_Effects_of_Patient_Point_of_Entry_and_Medicaid.13.aspx