Acute appendicitis: variation in outcomes by insurance status

Area of Science:

• Health Services Research
• Surgical Outcomes
• Health Economics

Background:

• Acute appendicitis (AA) serves as a model for acute care surgery research.
• Previous studies indicate disparities in AA outcomes based on insurance status.
• Healthcare system costs associated with insurance-based disparities require further investigation.

Purpose of the Study:

• To compare treatment, outcomes, and healthcare resource utilization for AA between uninsured and commercially insured patients.
• To analyze the impact of insurance status on appendicitis management and associated costs.

Main Methods:

• Utilized Florida Hospital inpatient discharge data (2002-2011) with International Classification of Diseases, ninth edition codes to identify AA patients.
• Examined outcomes including complicated vs. uncomplicated appendicitis, surgical approach (laparoscopic vs. open), perioperative complications, length of stay, and hospital costs.
• Employed logistic, negative binomial, and least squares multivariate regression, controlling for patient demographics, comorbidities, and hospital-fixed effects.

Main Results:

• Uninsured patients were more likely to present with complicated appendicitis (OR=1.31, P<0.01).
• The uninsured received laparoscopic appendectomy less frequently (OR=0.70, P<0.01).
• Uninsured individuals experienced longer hospital stays and incurred greater costs, with similar rates of perioperative complications compared to the insured.

Conclusions:

• Insurance status significantly influences healthcare utilization for acute appendicitis.
• The uninsured may delay care, leading to more complicated cases and higher treatment costs.
• Expanding insurance coverage, such as through the Affordable Care Act, could enhance patient outcomes and reduce healthcare expenditures for AA and potentially other acute surgical conditions.