Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital: A Retrospective Observational Study.
Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital: A Retrospective Observational Study.
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DOI：
10.1097/as9.0000000000000215
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发表时间：
2022-12
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保险类型与结直肠手术并发症、教科书结果(TO)和在安全网医院(SNH)的费用之间的关系。与负担较低的医院相比，SNH的手术并发症和成本更高。陈述敏锐度和保险类型如何影响结直肠手术结果？使用单站点国家外科质量改进计划(2013-2019年)进行的回顾性队列研究，使用成本数据并根据脆弱程度、术前严重急性情况(PASC)、病例状态和开放与腹腔镜术进行风险调整，以评估30天再手术、任何并发症、Clavien-Dindo IV(CDIV)并发症、TO和住院可变成本。患者平均年龄55.2岁(SD=13.4)，男性占53.1%。调整了虚弱、开放的腹部和紧急/急诊病例，医疗补助/未参保的患者出现PASC的几率(调整后的优势比=2.02，95%可信区间[CI]=1.223.52，P=0.009)高于私人患者。医疗补助/未参保(AOR=1.8，95%CI=1.28-2.55，P<；0.001)患者比私人患者更有可能接受紧急/紧急手术。与私人相比，医疗保险患者发生任何并发症和CDIV并发症的几率增加，而医疗补助/未参保患者发生任何并发症、急诊科或观察停留以及再次住院的几率增加。医疗保险(AOR=0.51，95%CI=0.33-0.88，P=0.003)和医疗补助/未参保(AOR=0.43，95%CI=0.30-0.60，P<；0.001)患者实现TO的几率低于私人患者。与私人患者相比，医疗补助/未参保患者的可变成本百分比变化增加到13.94%(P=0.005)，但在调整病例状态后相似。急诊/急诊(43.23%，P<；0.001)和任何并发症(78.34%，P<；0.001)增加了住院费用。减少紧急/紧急结直肠手术的发生率，可能通过改善获得护理的机会，可以在改善临床结果和降低费用方面产生更大的影响，特别是在医疗补助/未参保保险类型的患者中。一项回顾队列研究(1078例)，评估保险类型(私人保险、联邦医疗保险、医疗补助/未参保)与并发症和费用的关系，调整后的脆弱、开放与腹腔镜术，以及病例状态。与私人患者相比，医疗补助/未参保患者的紧急/紧急手术率显著增加，导致并发症的几率和费用增加。
Association of insurance type with colorectal surgical complications, textbook outcomes (TO), and cost in a safety-net hospital (SNH). SNHs have higher surgical complications and costs compared to low-burden hospitals. How does presentation acuity and insurance type influence colorectal surgical outcomes? 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. 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. 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. Mini-Abstract A retrospective cohort study (1078 cases) assessing the association of insurance type (Private, Medicare, Medicaid/uninsured) with complications and costs adjusted for frailty, open versus laparoscopic approach, and case status. Markedly increased rates of urgent/emergent surgeries in Medicaid/uninsured patients drive the increased odds of complications and costs compared to Private patients.