Study of Insurance Type on Operative Approach and Time to Operation of Elective Inguinal Hernia Repairs

This study examined whether insurance type is associated with operative approach and delays in elective inguinal hernia repairs.

This was a single-center retrospective review of elective inguinal hernia repairs from 2012 to 2021. Outcomes included operative approach and time from clinic visit to operation. Univariable associations with each outcome and insurance type (primary independent variable), as well as demographic, clinical, hernia, operative, and postoperative characteristics that were significant (P < 0.05), were entered into multivariable models. A multivariable logistic regression model predicting the odds of greater than the median number of days to operation (odds ratio; 95% confidence interval) and a multivariable time-to-event Cox proportional hazards model (hazard ratio; 95% confidence interval) were used.

One thousand two hundred six patients underwent inguinal hernia repairs (93% male, median age 58 y) with a median of 39 d to operation. On univariable analysis, privately insured patients more frequently underwent minimally invasive procedures (80%) compared to uninsured patients (43%; P < 0.001). The median time to operation differed for Medicaid (51 d), Medicare (41), and uninsured (37) patients versus private (34; P < 0.001). The multivariable logistic regression model demonstrated that Medicaid insurance coverage (1.79; 1.25-2.58) and robotic approach (1.70; 1.25-2.32) were associated with increased time to operation greater than the median of 39 d. The multivariable time-to-event model revealed that patients covered by Medicaid (0.78; 0.65-0.92) and uninsured patients (0.75; 0.62-0.91) experienced increased time to operation.

Medicaid and uninsured patients experienced longer time from clinic to operation. In addition, uninsured patients were more likely to have open repairs. Inequities in access to surgery need further investigation.