Discontinuous insurance coverage predicts prolonged hospital stay after pediatric adenotonsillectomy

Changes in health insurance coverage have been implicated in limiting access to care and increasing morbidity risk. The consequences of insurance discontinuity for surgical outcomes are unclear. In this study, we explored whether recent insurance discontinuity was associated with prolonged inpatient hospitalization after adenotonsillectomy in children.

We retrospectively evaluated single-center data on children aged 2-18 y undergoing adenotonsillectomy with overnight stay in 2009-2014. Insurance coverage at surgery and over the preceding year was categorized as (1) continuous private, (2) continuous Medicaid, or (3) discontinuous (changes or gaps in coverage). The association between insurance discontinuity and prolonged hospitalization (≥2 d) was evaluated using multivariable logistic regression.

The study included 1013 girls and 983 boys (aged 4.5 ± 2.9 y), of whom 205 (10%) required prolonged hospitalization. Insurance was continuous private for 749 patients (38%), continuous Medicaid for 1121 patients (56%), and discontinuous for 126 patients (6%). Prolonged stay was most common with discontinuous insurance (23/126, 18%), followed by continuous Medicaid (117/1,121, 10%), and continuous private insurance (65/749, 9%; P = 0.004). In multivariable analysis, discontinuous insurance remained associated with prolonged hospital stay, compared with continuous private insurance (odds ratio = 1.88; 95% confidence interval: 1.06-3.33; P = 0.031), and compared with continuous Medicaid (odds ratio = 1.86; 95% confidence interval: 1.09-3.19; P = 0.023).

This study demonstrates greater odds of prolonged hospitalization after adenotonsillectomy among children with recent gaps or changes in insurance coverage and illustrates the feasibility of studying influences of health insurance change on surgical outcomes using existing data in hospital electronic records.