Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital
Objective:. Association of insurance type with colorectal surgical complications, textbook outcomes (TO), and cost in a safety-net hospital (SNH). Background:. SNHs have higher surgical complications and costs compared to low-burden hospitals. How does presentation acuity and insurance type influenc...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2022-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000215 |
| _version_ | 1797859652397957120 |
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| author | Jasmine C. Tetley, DO Michael A. Jacobs, MS Jeongsoo Kim, PhD Susanne Schmidt, PhD Bradley B. Brimhall, MD, MPH Virginia Mika, PhD, MPH Chen-Pin Wang, PhD Laura S. Manuel, BS Paul Damien, PhD Paula K. Shireman, MD, MS, MBA |
| author_facet | Jasmine C. Tetley, DO Michael A. Jacobs, MS Jeongsoo Kim, PhD Susanne Schmidt, PhD Bradley B. Brimhall, MD, MPH Virginia Mika, PhD, MPH Chen-Pin Wang, PhD Laura S. Manuel, BS Paul Damien, PhD Paula K. Shireman, MD, MS, MBA |
| author_sort | Jasmine C. Tetley, DO |
| collection | DOAJ |
| description | Objective:. Association of insurance type with colorectal surgical complications, textbook outcomes (TO), and cost in a safety-net hospital (SNH).
Background:. SNHs have higher surgical complications and costs compared to low-burden hospitals. How does presentation acuity and insurance type influence colorectal surgical outcomes?
Methods:. Retrospective cohort study using single-site National Surgical Quality Improvement Program (2013–2019) with cost data and risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status and open versus laparoscopic to evaluate 30-day reoperations, any complication, Clavien-Dindo IV (CDIV) complications, TO, and hospitalization variable costs.
Results:. Cases (Private 252; Medicare 207; Medicaid/Uninsured 619) with patient mean age 55.2 years (SD = 13.4) and 53.1% male. Adjusting for frailty, open abdomen, and urgent/emergent cases, Medicaid/Uninsured patients had higher odds of presenting with PASC (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI] = 1.22–3.52, P = 0.009) versus Private. Medicaid/Uninsured (aOR = 1.80, 95% CI = 1.28–2.55, P < 0.001) patients were more likely to undergo urgent/emergent surgeries compared to Private. Medicare patients had increased odds of any and CDIV complications while Medicaid/Uninsured had increased odds of any complication, emergency department or observations stays, and readmissions versus Private. Medicare (aOR = 0.51, 95% CI = 0.33–0.88, P = 0.003) and Medicaid/Uninsured (aOR = 0.43, 95% CI = 0.30–0.60, P < 0.001) patients had lower odds of achieving TO versus Private. Variable cost %change increased in Medicaid/Uninsured patients to 13.94% (P = 0.005) versus Private but was similar after adjusting for case status. Urgent/emergent cases (43.23%, P < 0.001) and any complication (78.34%, P < 0.001) increased %change hospitalization costs.
Conclusions:. Decreasing the incidence of urgent/emergent colorectal surgeries, possibly by improving access to care, could have a greater impact on improving clinical outcomes and decreasing costs, especially in Medicaid/Uninsured insurance type patients. |
| first_indexed | 2024-04-09T21:34:09Z |
| format | Article |
| id | doaj.art-d97d27f7733742bd97cd7e0aca894755 |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-04-09T21:34:09Z |
| publishDate | 2022-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-d97d27f7733742bd97cd7e0aca8947552023-03-27T06:41:34ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932022-12-0134e21510.1097/AS9.0000000000000215202212000-00014Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net HospitalJasmine C. Tetley, DO0Michael A. Jacobs, MS1Jeongsoo Kim, PhD2Susanne Schmidt, PhD3Bradley B. Brimhall, MD, MPH4Virginia Mika, PhD, MPH5Chen-Pin Wang, PhD6Laura S. Manuel, BS7Paul Damien, PhD8Paula K. Shireman, MD, MS, MBA9From the * Department of Surgery, University of Texas Health San Antonio, San Antonio, TXFrom the * Department of Surgery, University of Texas Health San Antonio, San Antonio, TXFrom the * Department of Surgery, University of Texas Health San Antonio, San Antonio, TX† Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX‡ Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX§ University Health, San Antonio, TX† Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX† Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX∥ Department of Information, Risk, and Operations Management, Red McCombs School of Business, University of Texas, Austin, TXFrom the * Department of Surgery, University of Texas Health San Antonio, San Antonio, TXObjective:. Association of insurance type with colorectal surgical complications, textbook outcomes (TO), and cost in a safety-net hospital (SNH). Background:. SNHs have higher surgical complications and costs compared to low-burden hospitals. How does presentation acuity and insurance type influence colorectal surgical outcomes? Methods:. Retrospective cohort study using single-site National Surgical Quality Improvement Program (2013–2019) with cost data and risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status and open versus laparoscopic to evaluate 30-day reoperations, any complication, Clavien-Dindo IV (CDIV) complications, TO, and hospitalization variable costs. Results:. Cases (Private 252; Medicare 207; Medicaid/Uninsured 619) with patient mean age 55.2 years (SD = 13.4) and 53.1% male. Adjusting for frailty, open abdomen, and urgent/emergent cases, Medicaid/Uninsured patients had higher odds of presenting with PASC (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI] = 1.22–3.52, P = 0.009) versus Private. Medicaid/Uninsured (aOR = 1.80, 95% CI = 1.28–2.55, P < 0.001) patients were more likely to undergo urgent/emergent surgeries compared to Private. Medicare patients had increased odds of any and CDIV complications while Medicaid/Uninsured had increased odds of any complication, emergency department or observations stays, and readmissions versus Private. Medicare (aOR = 0.51, 95% CI = 0.33–0.88, P = 0.003) and Medicaid/Uninsured (aOR = 0.43, 95% CI = 0.30–0.60, P < 0.001) patients had lower odds of achieving TO versus Private. Variable cost %change increased in Medicaid/Uninsured patients to 13.94% (P = 0.005) versus Private but was similar after adjusting for case status. Urgent/emergent cases (43.23%, P < 0.001) and any complication (78.34%, P < 0.001) increased %change hospitalization costs. Conclusions:. Decreasing the incidence of urgent/emergent colorectal surgeries, possibly by improving access to care, could have a greater impact on improving clinical outcomes and decreasing costs, especially in Medicaid/Uninsured insurance type patients.http://journals.lww.com/10.1097/AS9.0000000000000215 |
| spellingShingle | Jasmine C. Tetley, DO Michael A. Jacobs, MS Jeongsoo Kim, PhD Susanne Schmidt, PhD Bradley B. Brimhall, MD, MPH Virginia Mika, PhD, MPH Chen-Pin Wang, PhD Laura S. Manuel, BS Paul Damien, PhD Paula K. Shireman, MD, MS, MBA Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital Annals of Surgery Open |
| title | Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital |
| title_full | Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital |
| title_fullStr | Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital |
| title_full_unstemmed | Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital |
| title_short | Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital |
| title_sort | association of insurance type with colorectal surgery outcomes and costs at a safety net hospital |
| url | http://journals.lww.com/10.1097/AS9.0000000000000215 |
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