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Multicenter Study
. 2015 Nov;194(5):1380-5.
doi: 10.1016/j.juro.2015.04.098. Epub 2015 Apr 30.

Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals

Lindsey A Herrel  1 , Zaojun Ye  1 , David C Miller  2
Affiliations
Multicenter Study

Utilization and Outcomes of Inpatient Urological Care at Safety Net Hospitals

Lindsey A Herrel et al. J Urol. 2015 Nov.

Abstract

Purpose: Because proposed funding cuts in the Patient Protection and Affordable Care Act may impact care for urological patients at safety net hospitals, we examined the use, outcomes and costs of inpatient urological surgery at safety net vs nonsafety net facilities prior to health care reform.

Materials and methods: Using the Nationwide Inpatient Sample we performed a retrospective cohort study of patients who underwent inpatient urological surgeries from 2007 through 2011. We defined the safety net burden of each hospital based on the proportion of Medicaid and self-pay discharges. We examined the distribution of urological procedures performed and compared in-hospital mortality, prolonged length of stay and costs in the highest quartile of burden (safety net) vs the lowest quartile (nonsafety net).

Results: The distribution of urological procedures differed by safety net status with less benign prostate surgery (9.1% safety net vs 11.4% nonsafety net) and major cancer surgery (26.9% vs 34.3%), and more reconstructive surgery (8.1% vs 5.5%) at safety net facilities (p <0.001). Higher mortality at safety net hospitals was seen for nephrectomy (OR 1.68, 95% CI 1.15-2.45) and transurethral resection of the prostate (OR 2.17, 95% CI 1.22-3.87). Patients in safety net hospitals demonstrated greater prolonged length of stay after endoscopic stone surgery (OR 1.20, 95% CI 1.01-1.41). Costs were similar across procedures except for radical prostatectomy and cystectomy. For these procedures the average admission was more expensive at nonsafety net facilities (prostatectomy $11,457 vs $9,610 and cystectomy $27,875 vs $24,048, each p <0.02).

Conclusions: Reductions in funding to safety net hospitals with health care reform could adversely impact access to care for patients with a broad range of urological conditions, potentially exacerbating existing disparities for vulnerable populations served by these facilities.

Keywords: Patient Protection and Affordable Care Act; healthcare disparities; hospitals; outcome assessment (health care); urologic surgical procedures.

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Conflict of interest statement

Conflicts of Interest: Dr. Herrel is a paid consultant for ArborMetrix, Inc., a company that provides software and analytics for assessing hospital quality and efficiency. Dr. Miller previously served as a consultant to ArborMetrix. The company had no role in conducting this study.

Figures

Figure 1
Figure 1
Distribution of inpatient urological cases according to safety net status.
Figure 2
Figure 2
Adjusted costs of common inpatient urological surgeries according to safety net status.
See this image and copyright information in PMC

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References

    1. Patient Protection and Affordable Care Act, HR 3590, 111th Cong (2009).

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