Primary payer status affects mortality for major surgical operations.
Primary payer status affects mortality for major surgical operations.
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主要付款人状况影响重大外科手术的死亡率。
DOI：
10.1097/sla.0b013e3181e8fd75
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发表时间：
2010-09
影响因子：
9
通讯作者：
Ailawadi G
中科院分区：
文献类型：
--
作者：
LaPar DJ;Bhamidipati CM;Mery CM;Stukenborg GJ;Jones DR;Schirmer BD;Kron IL;Ailawadi G
医疗补助和无保险人群是当前医疗改革的一个重要焦点。我们假设，在美国，大手术后的结果取决于主要支付者的地位。从2003年到2007年，使用全国住院患者样本（NIS）数据库评估了893,658例重大外科手术：肺切除术、食管切除术、结肠切除术、胰腺切除术、胃切除术、腹主动脉瘤修复术、髋关节置换术和冠状动脉搭桥术。患者按主要支付者身份分层：医疗保险（n = 491，829），医疗补助（n = 40，259），私人保险（n = 337，535）和无保险（n = 24，035）。采用多变量回归模型评估结果。与私人保险组（1.3%，P < 0.001）相比，医疗保险（4.4%;比值比[OR]，3.51）、医疗补助（3.7%; OR，2.86）和无保险（3.2%; OR，2.51）患者组的未调整死亡率更高。独立于手术的私人保险患者的死亡率最低。在控制了年龄、性别、收入、地理区域、手术和30种共病条件后，医疗补助支付者身份与最长住院时间和最高总费用相关（P < 0.001）。医疗补助（P < 0.001）和无保险（P < 0.001）支付者身份独立地赋予最高的调整后死亡风险。医疗补助和无保险的支付者身份增加了风险调整后的死亡率。医疗补助进一步与最大调整后的住院时间和总费用相关，尽管有风险因素或手术。这些差异是更大的社会经济和卫生系统相关问题的重要代表，这些问题可以用于改善美国患者的手术结局。
Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following major surgical operations in the United States is dependent on primary payer status. From 2003 to 2007, 893,658 major surgical operations were evaluated using the Nationwide Inpatient Sample (NIS) database: lung resection, esophagectomy, colectomy, pancreatectomy, gastrectomy, abdominal aortic aneurysm repair, hip replacement, and coronary artery bypass. Patients were stratified by primary payer status: Medicare (n = 491,829), Medicaid (n = 40,259), Private Insurance (n = 337,535), and Uninsured (n = 24,035). Multivariate regression models were applied to assess outcomes. Unadjusted mortality for Medicare (4.4%; odds ratio [OR], 3.51), Medicaid (3.7%; OR, 2.86), and Uninsured (3.2%; OR, 2.51) patient groups were higher compared to Private Insurance groups (1.3%, P < 0.001). Mortality was lowest for Private Insurance patients independent of operation. After controlling for age, gender, income, geographic region, operation, and 30 comorbid conditions, Medicaid payer status was associated with the longest length of stay and highest total costs (P < 0.001). Medicaid (P < 0.001) and Uninsured (P < 0.001) payer status independently conferred the highest adjusted risks of mortality. Medicaid and Uninsured payer status confers increased risk-adjusted mortality. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors or operation. These differences serve as an important proxy for larger socioeconomic and health system-related issues that could be targeted to improve surgical outcomes for US Patients.