保险状况对伸肌腱修复效果的影响

Surgeries Pub Date : 2024-02-29 DOI:10.3390/surgeries5010009
S. Dalton, Laura M Maharjan, Hayyan Yousuf, William F. Pientka
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引用次数: 0

摘要

背景:关于患者的保险状况如何影响伸肌腱损伤修复后的疗效,人们知之甚少。我们的目标是建立主要修复伸肌腱损伤的疗效与患者保险状况之间的关系。我们假设,参加商业保险的患者由于更容易获得术后手部治疗,且获得适当术后护理的障碍较少,因此会获得更好的治疗效果。方法:我们对在一家大型安全网医院接受任何区域(拇指除外)初级伸肌腱修复术的患者进行了回顾性病历审查。纳入标准包括至少八周的随访、完整的复查数据以及需要初级手术修复的伸肌腱损伤。研究对象包括四个组群:商业保险患者、医疗保险/医疗补助患者、县医院资助保险患者和无保险患者。统计分析采用 Chi-Square 和方差分析,显著性定义为 p≤ 0.05。结果:在纳入的 62 位患者(100 位数)中,20 位有商业保险,12 位有医疗保险/医疗补助,13 位有医院赞助的保险,17 位没有保险。除平均年龄外,各组在人口统计学数据、医疗合并症或数字特征方面均无显著差异。各组在平均随访时间、恢复全面活动时间或手术并发症方面也无明显差异。各组间的手术持续时间有明显差异,未参保患者的手术持续时间更长。各组的术后最终屈曲总运动弧(TAM)和伸展测量结果相似。此外,各组之间的手部治疗就诊次数也无明显差异。结论:伸肌腱修复术后,患者的保险状况不会影响最终活动范围、全面活动恢复或术后并发症等方面的结果。
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The Influence of Insurance Status on Extensor Tendon Repair Outcomes
Background: Little is known regarding how patient insurance status influences outcomes after extensor tendon-injury repair. We aim to establish a relationship between the outcomes of primarily repaired extensor tendon injuries and patient insurance status. We hypothesize that commercially insured patients will achieve superior outcomes due to more facile access to postoperative hand therapy and fewer barriers to appropriate postoperative care. Methods: A retrospective chart review was conducted of patients who underwent primary extensor tendon repair in any zone, excluding the thumb, at a single large safety-net hospital. Inclusion criteria included a minimum of eight weeks of follow-up, complete data available for review, and an extensor tendon injury requiring primary surgical repair. Four cohorts were examined: patients with commercial insurance, patients with Medicare/Medicaid, patients with county hospital-sponsored insurance, and uninsured patients. Statistical analysis was performed using Chi-Square and ANOVA analyses, with significance defined as p ≤ 0.05. Results: Of the 62 patients (100 digits) included, 20 had commercial insurance, 12 had Medicare/Medicaid, 13 had hospital-sponsored insurance, and 17 were uninsured. Except for mean age, there were no significant differences between groups in terms of demographic data, medical comorbidities, or digit characteristics. There were also no significant differences in mean follow-up, time to return to full activity, or surgical complications among groups. Procedure duration differed significantly between groups, with procedures lasting longer in uninsured patients. Postoperative final flexion total arc of motion (TAM) and extension measurements were similar across all groups. Additionally, hand therapy visits did not differ significantly between groups. Conclusions: Following extensor tendon repair, patient insurance status did not affect outcomes in terms of final range of motion, return to full activity, or postoperative complications.
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