Increased Access to Cardiac Surgery Did Not Improve Outcomes: Early Look Into Medicaid Expansion

Cohen, Brian D.; Zeymo, Alexander; Bouchard, Megan E.; McDermott, James; Shara, Nawar; Sellke, Frank W.; Sodha, Neel R.; Al‐Refaie, Waddah B.; Ehsan, Afshin

doi:10.1016/j.athoracsur.2021.09.025

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…Nine studies evaluated the relationship between Medicaid expansion and morbidity or mortality across 11 related outcomes. 16,17,21,22,28,35,41,42,44 Of these, 6 studies examined mortality outcomes, 1 study evaluated rate of major postoperative complications, 1 study evaluated readmission rates for AMI and HF, and 1 study evaluated the rate of out of hospital cardiac arrests. Morbidity or mortality improved 4 studies and did not change in 5 studies.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, Wadhera et al 41,42 found no difference in in-hospital mortality for individuals hospitalized with AMI or HF following Medicaid expansion. Similarly, Akhabue et al 22 found no association between Medicaid expansion and overall in-hospital mortality, and Cohen et al 17 found no difference in mortality or length of stay following Medicaid expansion for patients undergoing cardiac surgery.…”

Section: Morbidity or Mortalitymentioning

confidence: 98%

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Medicaid Expansion Under the Affordable Care Act and Association With Cardiac Care: A Systematic Review

Jiang

Urwin

Wasfy

2023

Circ: Cardiovascular Quality and Outcomes

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Background: The goal of the Affordable Care Act was to improve health outcomes through expanding insurance, including through Medicaid expansion. We systematically reviewed the available literature on the association of Affordable Care Act Medicaid expansion with cardiac outcomes. Methods: Consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed systematic searches in PubMed, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature using the keywords such as Medicaid expansion and cardiac, cardiovascular, or heart to identify titles published from 1/2014 to 7/2022 that evaluated the association between Medicaid expansion and cardiac outcomes. Results: A total of 30 studies met inclusion and exclusion criteria. Of these, 14 studies (47%) used a difference-in-difference study design and 10 (33%) used a multiple time series design. The median number of postexpansion years evaluated was 2 (range, 0.5–6) and the median number of expansion states included was 23 (range, 1–33). Commonly assessed outcomes included insurance coverage of and utilization of cardiac treatments (25.0%), morbidity/mortality (19.6%), disparities in care (14.3%), and preventive care (41.1%). Medicaid expansion was generally associated with increased insurance coverage, reduction in overall cardiac morbidity/mortality outside of acute care settings, and some increase in screening for and treatment of cardiac comorbidities. Conclusions: Current literature demonstrates that Medicaid expansion was generally associated with increased insurance coverage of cardiac treatments, improvement in cardiac outcomes outside of acute care settings, and some improvements in cardiac-focused prevention and screening. Conclusions are limited because quasi-experimental comparisons of expansion and nonexpansion states cannot account for unmeasured state-level confounders.

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Section: Resultsmentioning

confidence: 99%

Section: Morbidity or Mortalitymentioning

confidence: 98%

Medicaid Expansion Under the Affordable Care Act and Association With Cardiac Care: A Systematic Review

Jiang

Urwin

Wasfy

2023

Circ: Cardiovascular Quality and Outcomes

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“…It is worth noting that some studies have reported minimal or no improvements in outcomes for specific surgeries post-ACA. 19 Our research, by offering a large sample size, as well as a more focused evaluation of outcomes within a specific surgical procedure, adds granularity to the ongoing discussion.…”

Section: Discussionmentioning

confidence: 99%

Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States

Weldeslase,

Akinyemi,

Keeling

et al. 2024

The American Surgeon™

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Background The passage of the Affordable Care Act (ACA) in 2010 marked a pivotal moment in American health care policy, significantly expanding access to health care services. This study aims to explore the relationship between the ACA and the utilization and outcomes of Roux-en-Y Gastric Bypass (RYGB) surgery. Methods Using data from the National Inpatient Sample (NIS) Database, this retrospective study compares the pre-ACA period (2007-2009) with the post-ACA period (2017-2019), encompassing patients who had RYGB. Multivariable logistic analysis was done accounting for patient’s characteristics, comorbidities, and hospital type. Results In the combined periods, there were 158 186 RYGB procedures performed, with 30.0% transpiring in pre-ACA and 70.0% in the post-ACA. Post-ACA, the proportion of uninsured patients decreased from 4.8% to 3.6% ( P < .05), while Black patients increased from 12.5% to 18.5% ( P < .05). Medicaid-insured patients increased from 6.8% to 18.1% ( P < .05), and patients in the poorest income quartile increased from 20% to 26% ( P < .05). Patients in the post-ACA period were less likely to have longer hospital stays (OR = .16: 95% CI .16-.17, P < .01), in-hospital mortality (OR = .29: 95% CI .18-.46, P < .01), surgical site infection (OR = .25: 95% CI .21-.29, P < .01), postop hemorrhage (OR = .24: 95% CI .21-.28, P < .01), and anastomotic leak (OR = .14: 95% CI .10-.18, P < .01) than those in the pre-ACA period. Discussion Following the implementation of the ACA, utilization of bariatric surgery significantly increased, especially among Black patients, Medicaid beneficiaries, and low-income patients. Moreover, despite the inclusion of more high-risk surgical patients in the post-ACA period, there were better outcomes after surgery.

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Carotid Artery Stenting: Studies, Indications, and Pre-interventional Workup

Andraska,

Chaer

2024

Mastering Endovascular Techniques

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Increased Access to Cardiac Surgery Did Not Improve Outcomes: Early Look Into Medicaid Expansion

Cited by 4 publications

References 25 publications

Medicaid Expansion Under the Affordable Care Act and Association With Cardiac Care: A Systematic Review

Medicaid Expansion Under the Affordable Care Act and Association With Cardiac Care: A Systematic Review

Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States

Carotid Artery Stenting: Studies, Indications, and Pre-interventional Workup

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