Association of Insurance Type With Inpatient Surgery 30-Day Complications and Costs

Safety-net hospitals (SNHs) have higher postoperative complications and costs versus low-burden hospitals. Do low socioeconomic status/vulnerable patients receive care at lower-quality hospitals or are there factors beyond providers’ control? We studied the association of private, Medicare, and vuln...

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Veröffentlicht in:The Journal of surgical research 2023-02, Vol.282, p.22-33
Hauptverfasser: Simon, Richard C., Kim, Jeongsoo, Schmidt, Susanne, Brimhall, Bradley B., Salazar, Camerino I., Wang, Chen-Pin, Wang, Zhu, Sarwar, Zaheer U., Manuel, Laura S., Damien, Paul, Shireman, Paula K.
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Sprache:eng
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Zusammenfassung:Safety-net hospitals (SNHs) have higher postoperative complications and costs versus low-burden hospitals. Do low socioeconomic status/vulnerable patients receive care at lower-quality hospitals or are there factors beyond providers’ control? We studied the association of private, Medicare, and vulnerable insurance type with complications/costs in a high-burden SNH. Retrospective inpatient cohort study using National Surgical Quality Improvement Program (NSQIP) data (2013-2019) with cost data risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status, and expanded operative stress score (OSS) to evaluate 30-day unplanned reoperations, any complication, Clavien-Dindo IV (CDIV) complications, and hospitalization variable costs. Cases (Private 1517; Medicare 1224; Vulnerable 3648) with patient mean age 52.3 y [standard deviation = 14.7] and 47.3% male. Adjusting for frailty and OSS, vulnerable patients had higher odds of PASC (aOR = 1.71, CI = 1.39-2.10, P 
ISSN:0022-4804
1095-8673
1095-8673
DOI:10.1016/j.jss.2022.09.006