Patient Factors Limit Colon Cancer Survival at Safety-Net Hospitals: A National Analysis

Hrebinko, Katherine; Rieser, Caroline; Nassour, Ibrahim; Tohme, Samer; Sabik, Lindsay M.; Khan, Sidrah; Medich, David S.; Zureikat, Amer H.; Hoehn, Richard S.

doi:10.1016/j.jss.2021.03.012

Cited by 11 publications

(11 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 47 This suggests that poor outcomes are not a result of lower quality of care in SNH but due to patient-level differences. 48 While some groups have established SNH provide equitable care, 49 , 50 high-burden SNH have been associated with increased risk of complications 9 , 10 and costs. 5 Many colorectal surgery studies assess surgical outcomes across multiple healthcare systems based on safety-net burden 9 , 12 rather than within a healthcare system, which ultimately compares institutions with vastly different patient populations.…”

Section: Discussionmentioning

confidence: 99%

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

Tetley

Jacobs

Kim

et al. 2022

Annals of Surgery Open

View full text Add to dashboard Cite

Objective: Association of insurance type with colorectal surgical complications, textbook outcomes (TO), and cost in a safety-net hospital (SNH). Background: SNHs have higher surgical complications and costs compared to low-burden hospitals. How does presentation acuity and insurance type influence colorectal surgical outcomes? Methods: Retrospective cohort study using single-site National Surgical Quality Improvement Program (2013–2019) with cost data and risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status and open versus laparoscopic to evaluate 30-day reoperations, any complication, Clavien-Dindo IV (CDIV) complications, TO, and hospitalization variable costs. Results: Cases (Private 252; Medicare 207; Medicaid/Uninsured 619) with patient mean age 55.2 years (SD = 13.4) and 53.1% male. Adjusting for frailty, open abdomen, and urgent/emergent cases, Medicaid/Uninsured patients had higher odds of presenting with PASC (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI] = 1.22–3.52, P = 0.009) versus Private. Medicaid/Uninsured (aOR = 1.80, 95% CI = 1.28–2.55, P < 0.001) patients were more likely to undergo urgent/emergent surgeries compared to Private. Medicare patients had increased odds of any and CDIV complications while Medicaid/Uninsured had increased odds of any complication, emergency department or observations stays, and readmissions versus Private. Medicare (aOR = 0.51, 95% CI = 0.33–0.88, P = 0.003) and Medicaid/Uninsured (aOR = 0.43, 95% CI = 0.30–0.60, P < 0.001) patients had lower odds of achieving TO versus Private. Variable cost %change increased in Medicaid/Uninsured patients to 13.94% ( P = 0.005) versus Private but was similar after adjusting for case status. Urgent/emergent cases (43.23%, P < 0.001) and any complication (78.34%, P < 0.001) increased %change hospitalization costs. Conclusions: Decreasing the incidence of urgent/emergent colorectal surgeries, possibly by improving access to care, could have a greater impact on improving clinical outcomes and decreasing costs, especially in Medicaid/Uninsured insurance type patients.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Tetley

Jacobs

Kim

et al. 2022

Annals of Surgery Open

View full text Add to dashboard Cite

show abstract

“…32 Health facility factors that may contribute to poorer outcomes at SNHs include scarcity of preventive measures, 33 advanced disease at presentation, 34 and treatment delays. 13 Importantly, in this study, we have intentionally not controlled for race and socioeconomic status so as to not hold equal two fundamental differences between SNHs and hospitals service highest income, predominantly Caucasian population. We promote the use of cancer nurse navigators and culturally appropriate patient advocates to provide coordination and close follow-up for non-English speaking and low-health literacy patients.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Further, prior studies have investigated individual components of TOO (i.e., margin positivity, adequate lymphadenectomy, length of stay) while stratifying SNH burden, concluding that inferior outcomes in these individual metrics were seen at high SNH burden hospitals. 13 While individual quality measures have been assessed in the context of SNH burden, there remains a gap in knowledge of the comprehensive features which may underlie disparities in treatment outcomes. Utilizing a composite quality measure, such as TOO, may provide a more complete assessment of surgical cancer care at SNHs, thereby underlining potential targets for quality improvement.…”

Section: Introductionmentioning

confidence: 99%

Impact of safety‐net hospital burden on achievement of textbook oncologic outcomes following resection in for stage I–IV colorectal cancer

Wong,

Victorino,

Miraflor

et al. 2023

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and ObjectivesTextbook oncologic outcome (TOO) is a benchmark for high‐quality surgical cancer care but has not been studied at safety‐net hospitals (SNH). The study sought to understand how SNH burden affects TOO achievement in colorectal cancer.MethodsThe National Cancer Database was queried for colorectal cancer patients who underwent resection for stage I‐III plus stage IV with liver‐only metastases (2010–2019). TOO was defined as R0 resection, AJCC‐compliant lymphadenectomy (>12 nodes), no prolonged LOS, no 30‐day mortality/readmission, and receipt of stage‐appropriate adjuvant chemotherapy.ResultsOf 487,195 patients, 66.7% achieved TOO. Lower achievement was explained by adequate lymphadenectomy (87.3%), non‐prolonged LOS (76.3%), and receipt of adjuvant chemotherapy in stage III (60.3%) and IV (54.1%). Treatment at high burden hospitals (HBH, >10% Medicaid/uninsured) was a predictor of non‐TOO (Stage I/II: OR 0.83, III: OR 0.86, IV: OR 0.83; all p < 0.001). Achieving TOO was associated with decreased mortality (Stage I/II: HR 0.49, III: HR 0.48, IV: HR 0.57; all p < 0.001), and HBH treatment was a predictor of mortality (Stage I/II: HR 1.09, III: HR 1.05, IV: HR 1.07; all p < 0.05).ConclusionsTreatment at higher SNH burden hospitals was associated with less frequent TOO achievement and increased mortality. Quality improvement targets include receipt of adjuvant chemotherapy and avoidance of prolonged LOS.

show abstract

“…Others have also reported inferior outcomes in patients with cancers of the colon, larynx, and esophagus. 13 , 16 , 17 In contrast, studies investigating this relationship in patients with cancers of the rectum, pancreas, and head and neck have reported equivalent outcomes irrespective of hospital payer mix. 18 , 19 , 20 It is possible that the factors that affect treatment quality and outcomes differ by type of cancer and procedure and should be the focus of subsequent studies.…”

Section: Discussionmentioning

confidence: 99%

Treatment quality and outcomes vary with hospital burden of uninsured and Medicaid patients with cancer in early non–small cell lung cancer

et al. 2022

View full text Add to dashboard Cite

Patient Factors Limit Colon Cancer Survival at Safety-Net Hospitals: A National Analysis

Cited by 11 publications

References 25 publications

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

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

Impact of safety‐net hospital burden on achievement of textbook oncologic outcomes following resection in for stage I–IV colorectal cancer

Treatment quality and outcomes vary with hospital burden of uninsured and Medicaid patients with cancer in early non–small cell lung cancer

Contact Info

Product

Resources

About