Unplanned Surgery in Dually Eligible Beneficiaries for Conditions that Should Be Treated Electively

To evaluate the rate of unplanned surgery among dually eligible beneficiaries for surgical conditions that should be treated electively.

Access-sensitive surgical conditions (eg, abdominal aortic aneurysm repair, colectomy for colon cancer, and ventral hernia repair) are ideally treated with elective surgery, but when left untreated have a natural history leading to unplanned surgery. Dually eligible beneficiaries may face systematic barriers to accessing surgical care.

Cross-sectional retrospective study of all beneficiaries who were eligible for both Medicare and Medicaid and underwent surgery for an access-sensitive surgical condition between 2016 and 2020. We compared the rate of unplanned surgery as well as 30-day mortality, complications, and readmissions for dually eligible versus non-dually eligible beneficiaries. Gender, age, race/ethnicity, comorbidities, teaching status, nursing ratio, hospital region and bed size, and surgery year were included in the risk-adjustment model.

Out of 853,500 beneficiaries, 118,812 were dually eligible, with an average age (SD) of 75.2(7.7) years. Compared with nondually eligible beneficiaries, dually eligible beneficiaries had higher rates of unplanned surgery for access-sensitive surgical conditions (45.1% vs. 31.8%, P <0.001), 30-day mortality (2.9% vs. 2.6%, aOR=1.10 (1.07-1.14), P <0.001), complications (23.6% vs. 20.1%, aOR=1.23 (1.20-1.25), P <0.001), and 30-day readmissions (15.5% vs. 12.9%, aOR=1.24 (1.22-1.27), P <0.001). These differences narrowed significantly when evaluating elective procedures only.

Dually eligible beneficiaries were more likely to undergo unplanned surgery for access-sensitive surgical conditions, leading to worse rates of mortality, complications, and readmissions. Our findings suggest that improving rates of elective surgery for these conditions represents an actionable target to narrow the difference in postoperative outcomes between dually eligible and non-dually eligible beneficiaries.