Worse outcomes among uninsured general surgery patients: Does the need for an emergency operation explain these disparities?

Schwartz, David R.; Hui, Xuan; Schneider, Eric B.; Ali, Mays T.; Canner, Joseph K.; Leeper, W. Robert; Efron, David T.; Haut, Elliott R.; Velopulos, Catherine G.; Pawlik, Timothy M.; Haider, Adil H.

doi:10.1016/j.surg.2014.04.039

Cited by 77 publications

(57 citation statements)

References 19 publications

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“…24–27 One source of this disparity is the difference in access to high quality surgical care. 28–31 At the same time, however, there are higher proportions of Medicaid primary patients geographically clustered around traditionally high quality care hospitals including high volume, urban, teaching hospitals.…”

Section: Commentsmentioning

confidence: 99%

Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act

Hall

Zheng

Langan

et al. 2016

The American Journal of Surgery

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BACKGROUND Medicaid beneficiaries do not have equal access to high-volume centers for complex surgical procedures. We hypothesize there is a large Medicaid Gap between those receiving emergency general vs complex surgery at the same hospital. METHODS Using the Nationwide Inpatient Sample, 1998 to 2010, we identified high-volume pancreatectomy hospitals. We then compared the percentage of Medicaid patients receiving appendectomies vs pancreatectomies at these hospitals. Hospital characteristics associated with increased Medicaid Gap were evaluated using generalized estimating equation models. RESULTS A total of 602 hospital-years of data from 289 high-volume pancreatectomy hospitals were included. Median percentages of Medicaid appendectomies and pancreatectomies were 12.1% (interquartile range: 5.8% to 19.8%) and 6.7% (interquartile range: 0% to 15.4%), respectively. Hospitals that performed greater than or equal to 40 pancreatic resections per year had higher odds of having significant Medicaid Gap (odds ratio 2.3, 95% confidence interval 1.1 to 5.0). CONCLUSIONS Gaps exist between the percentages of Medicaid patients receiving emergency general surgery vs more complex surgical care at the same hospital and may be exaggerated in hospitals with very high volume of complex elective surgeries.

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Section: Commentsmentioning

confidence: 99%

Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act

Hall

Zheng

Langan

et al. 2016

The American Journal of Surgery

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“…They found that slightly fewer white patients and slightly more black patients were among the group in which the attending was not present in the operating room but available. This was attributed to the finding that emergent surgeries were required more frequently in minorities 19 and further supported by Schwartz et al, 22 who found that emergent operations were more likely in black and Hispanic men.…”

Section: Article In Pressmentioning

confidence: 67%

Racial disparities in surgical outcomes: Does the level of resident surgeon play a role?

Changoor

Ortega

Ekladios

et al. 2015

Surgery

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“…These high-risk individuals with significantly higher rates of medical comorbidities require higher resource utilization as demonstrated by our cost analysis 15–19 . Specific attention to this population will be critical during the roll out of ACO’s to mitigate financial risk in the care of these patients 20,21 .…”

Section: Discussionmentioning

confidence: 81%

Access to Quaternary Care Surgery: Implications for Accountable Care Organizations

Mehaffey

Hawkins

Mullen

et al. 2017

Journal of the American College of Surgeons

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Background Accountable Care Organizations (ACO) attempt to provide the most efficient and effective care to patients within a region. We hypothesize that patients who undergo surgery closer to home have improved survival due to proximity of preoperative and post-discharge care. Study Design All (17,582) institutional American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patients with a documented zip code and predicted risk who underwent surgery at our institution (2005–2014) were evaluated. Travel times were calculated by Google Maps, and patients were stratified by 1 hour of travel (local vs regional). Multivariable logistic regression and Cox Proportional Hazard models were used to evaluate the NSQIP risk-adjusted effects of travel time on operative morbidity, mortality, and long-term survival. Results Median travel time was 65 minutes with regional patients demonstrating significantly higher rates of ascites, hypertension, diabetes, disseminated cancer, >10% weight-loss, higher ASA, higher predicted risk of morbidity and mortality and lower functional status (all p<0.01). After adjusting for ACS NSQIP predicted risk, travel time was not significantly associated with 30-day mortality (OR 1.06, p=0.42) or any major morbidities (all p>0.05). However, survival analysis demonstrated travel time is an independent predictor of long-term mortality (OR 1.24, p<0.001) Conclusions Patients traveling farther for care at a quaternary center had higher rates of comorbidities and predicted risk of complications. Additionally, travel time predicts risk-adjusted long-term mortality, suggesting a major focus of ACOs will need to be integration of care at the periphery of their region.

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Worse outcomes among uninsured general surgery patients: Does the need for an emergency operation explain these disparities?

Cited by 77 publications

References 19 publications

Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act

Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act

Racial disparities in surgical outcomes: Does the level of resident surgeon play a role?

Access to Quaternary Care Surgery: Implications for Accountable Care Organizations

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