Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA.
Cancer. 2012 Apr 1;118(7):1803-10. doi: 10.1002/cncr.26475. Epub 2011 Aug 25.
Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short-term RP outcomes.
Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003-2007). We tested the rates of blood transfusions, extended length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to insurance status. Multivariable logistic regression analyses, fitted with general estimation equations for clustering among hospitals, adjusted for confounding factors.
Overall, 61,167 RPs were identified. Of those, private insurance accounted for the majority of cases (n = 41,312, 67.5%), followed by Medicare (n = 18,759, 30.7%) and Medicaid (n = 1096, 1.8%). Insurance status other than private was associated with higher rates of blood transfusions (P < .001), higher overall postoperative complication rates (P < .001), higher rates of hospital stay above the median (P < .001), as well as higher in-hospital mortality (P = .01). In multivariable analyses, compared with patients with private insurance, Medicaid patients had higher rates of blood transfusion (odds ratio [OR] = 1.45, P < .001), length of stay beyond the median (OR = 1.61, P < .001) postoperative complications (OR= 1.24, P = .02), and in-hospital mortality (OR = 4.91, = .01). Similarly, Medicare patients had higher rates of blood transfusions (OR = 1.21, P < .001), overall postoperative complications (OR = 1.17, P×< .001) and length of stay beyond the median (OR = 1.25, P < .001).
Even after adjusting for confounding factors, patients with private insurance have better outcomes than their counterparts with nonprivate insurance.
私人保险状况可能对各种健康结果产生有利影响，包括与根治性前列腺切除术（RP）相关的结果。我们探讨了保险状况对 5 项短期 RP 结果的影响。
在医疗保健利用项目全国住院患者样本（NIS）中，我们专注于在最近 5 年（2003-2007 年）内进行的 RP。我们根据保险状况，测试了输血、延长住院时间、术中及术后并发症以及住院内死亡率的发生率。多变量逻辑回归分析，使用一般估计方程进行医院间聚类调整混杂因素。
总体而言，我们确定了 61167 例 RP。其中，私人保险占大多数病例（n=41312，67.5%），其次是医疗保险（n=18759，30.7%）和医疗补助（n=1096，1.8%）。除私人保险以外的保险状况与输血率较高相关（P<.001）、整体术后并发症发生率较高（P<.001）、高于中位数的住院时间率较高（P<.001）以及住院内死亡率较高（P=0.01）。在多变量分析中，与私人保险患者相比，医疗补助患者输血率较高（优势比[OR] = 1.45，P<.001）、中位以上的住院时间（OR = 1.61，P<.001）、术后并发症（OR=1.24，P=0.02）和住院内死亡率（OR = 4.91，P=0.01）较高。同样，医疗保险患者输血率较高（OR = 1.21，P<.001）、整体术后并发症（OR = 1.17，P<.001）和中位以上的住院时间（OR = 1.25，P<.001）较高。
即使在调整混杂因素后，私人保险患者的结局也优于非私人保险患者。
