The Disparity of Care and Outcomes for Medicaid Patients Undergoing Colectomy

J Surg Res. 2019 Mar;235:190-201. doi: 10.1016/j.jss.2018.09.056. Epub 2018 Oct 29.

Abstract

Background: Colectomies are one of the most common surgeries in the United States with about 275,000 performed annually. Studies have shown that insurance status is an independent risk factor for worse surgical outcomes. This study aims to analyze the effect of insurance on health outcomes of patients undergoing colectomy procedures.

Methods: We examined hospital discharge data from the State Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, from 2009 to 2014 in California, Florida, New York, Maryland, and Kentucky. The primary outcome was in-hospital mortality. Secondary outcomes included complications, length of stay (LOS), total hospital charges, and 30- and 90-d readmissions.

Results: A total of 444,877 patients were included in the analysis. Bivariate analysis showed that open surgeries were more common in Medicaid patients (50.5%), whereas robotic and laparoscopic surgeries were more common in private insurance holders (50.4% and 21.7%, respectively). In the adjusted multivariate models, when compared with private insurance patients, Medicaid patients had the highest odds ratio (OR) for mortality (OR, 1.96; 95% confidence interval [CI], 1.78-2.15), complication rates (OR, 1.43; 95% CI, 1.38-1.49), 30-d readmission (OR, 1.47; 95% CI, 1.40-1.55), 90-d readmission (OR, 1.44; 95% CI, 1.37-1.51), longer LOS (coefficient, 1.26; 95% CI, 1.24-1.28), and higher total hospital charges (coefficient, 1.15; 95% CI, 1.13-1.17).

Conclusions: We identified Medicaid insurance status as a predictor of open colectomies and of higher mortality, LOS, complications, readmission rates, and charges after colectomy. Further research and initiatives are necessary to meet the specific needs of patients with different payer types.

Keywords: Colectomy; Health-care disparities; Medicaid; Mortality; Outcomes research; Primary payer status.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colectomy / methods
  • Colectomy / mortality*
  • Female
  • Healthcare Disparities
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data*
  • Humans
  • Insurance Coverage*
  • Laparoscopy / statistics & numerical data*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Robotic Surgical Procedures / statistics & numerical data*
  • United States / epidemiology