Schweitzer Jeremy, Fairman Nathan, Schreyer Kristin, Waxman Kenneth
Department of Surgical Education, Santa Barbara Cottage Hospital, Santa Barbara, California 93102, USA.
Am Surg. 2003 Oct;69(10):902-8.
As the status of health-care insurance changes in the United States, studies have indicated that uninsured patients are less likely to receive timely and quality health care. Previous studies of appendicitis have shown that insurance status may effect the stage of presentation and outcome. However, these studies were based on databases lacking information regarding stage of presentation, timeliness of diagnosis and treatment, and character of hospitalization (length of stay, duration of antibiotic therapy, hospital costs). We accomplished a case control study, retrospective analysis of 975 patients treated for acute appendicitis between January 1996 and December 1999. Times to operation, number of preoperative outpatient visits, number of studies, severity of presentation, length of antibiotics and hospital stay, and hospital costs were analyzed [analysis of variance (ANOVA) techniques, P < 0.05 significant]. We sought answers to the following: (1) Did insurance status affect the timeliness of diagnosis and treatment? (2) Did insurance status affect the stage of presentation? (3) Did insurance status affect hospitalization, as measured by length of stay, duration of antibiotic therapy, and hospital costs? (4) Did age affect outcome independent of insurance status? There were no correlations between insurance status and timeliness of diagnosis or severity of presentation. Length of stay and hospital costs were also not different between insurance categories. Pediatric patients (< 12 years old) and the elderly (> 65 years old) presented with more advanced appendicitis, independent of insurance category. In contrast to previously published data, the treatment of acute appendicitis is not affected by insurance coverage in the sample community. Age and timeliness of presentation were the only factors correlating to outcomes.
随着美国医疗保险状况的变化，研究表明未参保患者获得及时和优质医疗服务的可能性较小。先前关于阑尾炎的研究表明，保险状况可能会影响疾病的就诊阶段和治疗结果。然而，这些研究是基于缺乏就诊阶段、诊断和治疗及时性以及住院特征（住院时间、抗生素治疗持续时间、住院费用）信息的数据库进行的。我们完成了一项病例对照研究，对1996年1月至1999年12月期间接受急性阑尾炎治疗的975例患者进行回顾性分析。分析了手术时间、术前门诊就诊次数、检查次数、病情严重程度、抗生素使用时间和住院时间以及住院费用[采用方差分析（ANOVA）技术，P<0.05为有统计学意义]。我们试图回答以下问题：（1）保险状况是否影响诊断和治疗的及时性？（2）保险状况是否影响就诊阶段？（3）保险状况是否影响住院情况，以住院时间、抗生素治疗持续时间和住院费用衡量？（4）年龄是否独立于保险状况影响治疗结果？保险状况与诊断及时性或病情严重程度之间没有相关性。不同保险类别之间的住院时间和住院费用也没有差异。儿科患者（<12岁）和老年患者（>65岁）出现更晚期的阑尾炎，与保险类别无关。与先前发表的数据相反，样本社区中急性阑尾炎的治疗不受保险覆盖范围的影响。年龄和就诊及时性是与治疗结果相关的唯一因素。
