The interaction of race and insurance type on length of stay and discharge disposition following reverse total shoulder arthroplasty: A statewide database study

Background Reverse total shoulder arthroplasty (rTSA) utilization is increasing, making perioperative resource use an important target for value-based care. This study evaluated whether race and insurance type are associated with length of stay (LOS) and discharge disposition after rTSA. Methods Patients undergoing rTSA between 2016 and 2020 were identified in the New York Statewide Planning and Research Cooperative System database. Race was categorized as White, Black, or Other, and insurance as commercial, Medicare, Medicaid, or Workers’ Compensation. Mixed-effects multivariable models assessed LOS and probability of home discharge across race-insurance groups. Results Among 13,824 patients, 86.9% were White, 8.22% Other, and 4.81% Black. Medicare was most common (66.9%), followed by commercial insurance (25.3%), Workers’ Compensation (5.60%), and Medicaid (2.30%). Mean LOS was 1.72 ± 1.5 days, and 69.3% were discharged home. Among commercially insured patients, Black patients had longer LOS than White patients (estimate, 0.39 days; 95% CI: 0.15 to 0.64; p = . 002) and a lower probability of home discharge (estimate, −13.9 percentage points; 95% CI: −20.74 to −7.11; p < . 001). Discussion Race-insurance intersections were associated with LOS and discharge disposition after rTSA, suggesting persistent disparities in perioperative care pathways.