Association of Insurance Type With Inpatient Surgery 30-Day Complications and Costs

Area of Science:

• Health Services Research
• Surgical Outcomes
• Health Economics

Background:

• Safety-net hospitals (SNHs) often manage higher patient burdens and may exhibit increased postoperative complications and costs.
• Disparities in care quality for vulnerable populations in SNHs require investigation into contributing factors beyond provider control.

Purpose of the Study:

• To examine the association between insurance type (private, Medicare, vulnerable) and postoperative complications and costs within a high-burden SNH.
• To determine if patient insurance status, rather than provider factors, influences outcomes and healthcare expenditures.

Main Methods:

• A retrospective cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database (2013-2019).
• Risk adjustment for patient frailty, preoperative serious acute conditions (PASC), case status, and operative stress score (OSS).
• Evaluation of 30-day unplanned reoperations, any complication, severe complications (Clavien-Dindo IV), and hospitalization variable costs.

Main Results:

• Vulnerable patients had higher odds of PASC and urgent/emergent surgeries compared to privately insured patients.
• Medicare and vulnerable patients were more likely to undergo urgent/emergent surgeries, increasing complication odds.
• While variable costs were similar between private and vulnerable patients after adjustment, urgent/emergent cases significantly increased costs by 32.31%.

Conclusions:

• Increased presentation acuity (PASC and urgent/emergent surgeries) in vulnerable patients drives higher complication rates and costs.
• Factors such as access to care, leading to urgent/emergent presentations, appear to be beyond provider control and significantly impact outcomes.
• Improving access to timely care is crucial for mitigating disparities in surgical outcomes and costs for vulnerable populations.