Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital

Tetley, Jasmine C.; Jacobs, Michael A.; Kim, Jeongsoo; Schmidt, Susanne; Brimhall, Bradley B.; Mika, Virginia; Wang, Chen-Pin; Manuel, Laura; Damien, Paul; Shireman, Paula K.

doi:10.1097/as9.0000000000000215

Cited by 9 publications

(7 citation statements)

References 54 publications

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“…Of note, insurance status was also strongly associated with the likelihood to undergo emergent resection of CC. Tetley et al similarly noted an association of insurance type with colorectal surgery outcomes 30 . Other studies have also demonstrated the impact of social vulnerability and residential segregation on the likelihood to undergo emergent versus elective colon surgery 31 .…”

Section: Discussionmentioning

confidence: 97%

“…Tetley et al similarly noted an association of insurance type with colorectal surgery outcomes. 30 Other studies have also demonstrated the impact of social vulnerability and residential segregation on the likelihood to undergo emergent versus elective colon surgery. 31 In the AI model, four of the five most important variables associated with emergent surgery were clinicopathologic and operative factors, demonstrating the importance of adhering to oncologic standards of care.…”

Section: Discussionmentioning

confidence: 99%

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Artificial intelligence to investigate predictors and prognostic impact of time to surgery in colon cancer

Alaimo

Moazzam

Woldesenbet

et al. 2023

Journal of Surgical Oncology

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Background and Objectives The role of time to surgery (TTS) for long‐term outcomes in colon cancer (CC) remains ill‐defined. We sought to utilize artificial intelligence (AI) to characterize the drivers of TTS and its prognostic impact. Methods The National Cancer Database was utilized to identify patients diagnosed with non‐metastatic CC between 2004 and 2018. AI models were employed to rank the importance of several sociodemographic, facility, and tumor characteristics in determining TTS, and postoperative survival. Results Among 518 983 patients, 137 902 (26.6%) received intraoperative diagnosis of CC (TTS = 0), while 381 081 (74.4%) underwent elective surgery (TTS > 0) with median TTS of 19.0 days (interquartile range [IQR]: 7.0−33.0). An AI model, identified tumor stage, receipt of adequate lymphadenectomy, histologic grade, lymphovascular invasion, and insurance status as the most important variables associated with TTS = 0. Conversely, the type and location of treating facility and receipt of adjuvant therapy were among the most important variables for TTS > 0. Notably, TTS was among the most important variables associated with survival, and TTS > 3 weeks was associated with an incremental increase in mortality risk. Conclusions The identification of factors associated with TTS can help stratify patients most likely to suffer poor outcomes due to prolonged TTS, as well as guide quality improvement initiatives related to timely surgical care.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Artificial intelligence to investigate predictors and prognostic impact of time to surgery in colon cancer

Alaimo

Moazzam

Woldesenbet

et al. 2023

Journal of Surgical Oncology

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“…Uninsured and Medicaid patients are more likely to present acutely and undergo emergent colectomy for CRC as compared with privately insured individuals. 3 31 Even when patients are seen in a timely fashion to pursue elective management, uninsured or publicly insured patients are more likely to decline surgery, which may impact their overall survival. 32 33 When these patients do undergo surgery, they are less likely to receive laparoscopic or robotic surgery compared with privately insured patients.…”

Section: Barriers To Colorectal Surgery Care Among Uninsured and Unde...mentioning

confidence: 99%

“…1 2 This is particularly true for patients with benign and malignant colorectal surgery conditions that often require longitudinal care and costly surgical treatment. 3 The objectives of this chapter are twofold. First, we seek to explore clinical outcomes for colorectal surgery patients who are uninsured or underinsured and outline barriers to accessing optimal care.…”

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confidence: 99%

Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Isenberg,

Harbaugh

2024

Clin Colon Rectal Surg

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Health insurance plays a critical role in access to and delivery of health care in the United States. As the only industrialized nation without universal health coverage, Americans without adequate insurance (i.e., uninsured or underinsured individuals) face numerous obstacles to obtaining necessary health care. In this article, we review the mechanisms by which inadequate insurance leads to worse clinical outcomes in patients with common benign and malignant colorectal pathologies. We then discuss several evidence-based solutions for improving access to optimal colorectal care for these patients. These include increasing access to and affordability of health insurance, mitigating disparities between differently insured populations, strengthening the health care safety net, and tailoring outreach and clinical decision-making for the uninsured and underinsured. By exploring the nuance and impact of inadequate insurance coverage, we ultimately seek to highlight critical opportunities for future research and advocacy within the realm of insurance design and policy.

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“…Urgent surgeries have worse surgical outcomes than elective procedures . In addition, urgent cases are more prevalent than emergent cases in vulnerable populations . Furthermore, the large numbers of patients in these databases enable detecting significant differences that may not be usable at a health care–system level.…”

Section: Introductionmentioning

confidence: 99%

Presentation Acuity and Surgical Outcomes for Patients With Health Insurance Living in Highly Deprived Neighborhoods

Schmidt,

Jacobs,

Kim

et al. 2024

JAMA Surg

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ImportanceInsurance coverage expansion has been proposed as a solution to improving health disparities, but insurance expansion alone may be insufficient to alleviate care access barriers.ObjectiveTo assess the association of Area Deprivation Index (ADI) with postsurgical textbook outcomes (TO) and presentation acuity for individuals with private insurance or Medicare.Design, Setting, and ParticipantsThis cohort study used data from the National Surgical Quality Improvement Program (2013-2019) merged with electronic health record data from 3 academic health care systems. Data were analyzed from June 2022 to August 2023.ExposureLiving in a neighborhood with an ADI greater than 85.Main Outcomes and MeasuresTO, defined as absence of unplanned reoperations, Clavien-Dindo grade 4 complications, mortality, emergency department visits/observation stays, and readmissions, and presentation acuity, defined as having preoperative acute serious conditions (PASC) and urgent or emergent cases.ResultsAmong a cohort of 29 924 patients, the mean (SD) age was 60.6 (15.6) years; 16 424 (54.9%) were female, and 13 500 (45.1) were male. A total of 14 306 patients had private insurance and 15 618 had Medicare. Patients in highly deprived neighborhoods (5536 patients [18.5%]), with an ADI greater than 85, had lower/worse odds of TO in both the private insurance group (adjusted odds ratio [aOR], 0.87; 95% CI, 0.76-0.99; P = .04) and Medicare group (aOR, 0.90; 95% CI, 0.82-1.00; P = .04) and higher odds of PASC and urgent or emergent cases. The association of ADIs greater than 85 with TO lost significance after adjusting for PASC and urgent/emergent cases. Differences in the probability of TO between the lowest-risk (ADI ≤85, no PASC, and elective surgery) and highest-risk (ADI &gt;85, PASC, and urgent/emergent surgery) scenarios stratified by frailty were highest for very frail patients (Risk Analysis Index ≥40) with differences of 40.2% and 43.1% for those with private insurance and Medicare, respectively.Conclusions and RelevanceThis study found that patients living in highly deprived neighborhoods had lower/worse odds of TO and higher presentation acuity despite having private insurance or Medicare. These findings suggest that insurance coverage expansion alone is insufficient to overcome health care disparities, possibly due to persistent barriers to preventive care and other complex causes of health inequities.

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Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital

Cited by 9 publications

References 54 publications

Artificial intelligence to investigate predictors and prognostic impact of time to surgery in colon cancer

Artificial intelligence to investigate predictors and prognostic impact of time to surgery in colon cancer

Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Presentation Acuity and Surgical Outcomes for Patients With Health Insurance Living in Highly Deprived Neighborhoods

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