Berger Alexander A, Giugale Lauren E, Shepherd Jonathan P
Female Pelvic Med Reconstr Surg. 2018 Mar/Apr;24(2):90-94. doi: 10.1097/SPV.0000000000000501.
We examined the impact of the implementation of the Affordable Care Act (ACA) on female pelvic medicine and reconstructive surgery (FPMRS) surgical cancelation rates.
A retrospective cohort study was performed on patients scheduling FPMRS procedures 1 year before and after ACA implementation at a regional academic medical center. We compared cancelation rates as well as sociodemographic, surgical, and medical history data. Analysis included χ test, t test, and univariable and multivariable logistic regression.
We included 746 subjects, 373 each before and after ACA implementation (January 2014). Subjects were 59.2 ± 14.0 years old, predominantly white (94.9%), employed (45.8%), and married (66.6%), with a body mass index of 28.8 ± 6.2. Subjects lived a median of 24 miles from the hospital. None of these were significant predictors of cancelations. Surgery cancelation rate was 17.1% and occurred 9 days before surgery.On univariable analysis, cancelation rates did not differ relative to the ACA (15.5% before vs 18.6% after; mean difference, 3.16%; 95% confidence interval [CI], -2.29% to 8.69%; P = 0.254). Only 3 variables impacted cancelation rate on univariable analysis: women whose surgery was scheduled for later in the week, liver/renal disease, and minor vs major surgery.On multivariable regression including variables with P < 0.20 as candidate variables, the same 3 variables remained significant. Cancelations increased with procedures scheduled later in the week (odds ratio [OR], 1.169 per day; 95% CI, 1.004-1.361) and liver or renal disease (OR, 2.342; 95% CI, 1.015-5.405). Major procedures had fewer cancelations (OR, 0.625; 95% CI, 0.414-0.943). The ACA implementation of still did not impact cancelations (OR, 1.230; 95% CI, 0.831-1.821).
The implementation of the ACA did not impact FPMRS cancelation rates. Significant predictors of surgical cancelation included later day of the week, comorbid renal or liver disease, and performance of a minor procedure.
我们研究了《平价医疗法案》（ACA）的实施对女性盆底医学与重建外科手术（FPMRS）取消率的影响。
在一家地区性学术医疗中心，对ACA实施前后1年安排FPMRS手术的患者进行了一项回顾性队列研究。我们比较了取消率以及社会人口统计学、手术和病史数据。分析包括χ检验、t检验以及单变量和多变量逻辑回归。
我们纳入了746名受试者，ACA实施前后各373名（2014年1月）。受试者年龄为59.2±14.0岁，主要为白人（94.9%），就业者（45.8%），已婚（66.6%），体重指数为28.8±6.2。受试者居住在距离医院中位数为24英里的地方。这些均不是取消手术的显著预测因素。手术取消率为17.1%，发生在手术前9天。单变量分析显示，取消率与ACA实施情况无关（实施前为15.5%，实施后为18.6%；平均差异为3.16%；95%置信区间[CI]为-2.29%至8.69%；P = 0.254）。单变量分析中只有3个变量影响取消率：手术安排在本周晚些时候的女性、肝脏/肾脏疾病以及小手术与大手术。在将P<0.20的变量作为候选变量纳入的多变量回归分析中，同样的3个变量仍然显著。取消率随着本周晚些时候安排的手术（比值比[OR]为每天1.169；95%CI为1.004 - 1.361）以及肝脏或肾脏疾病（OR为2.342；95%CI为1.015 - 5.405）而增加。大手术的取消率较低（OR为0.625；95%CI为0.414 - 0.943）。ACA的实施仍然没有影响取消率（OR为1.230；95%CI为0.831 - 1.821）。
ACA的实施没有影响FPMRS的取消率。手术取消的显著预测因素包括本周晚些时候、合并肾脏或肝脏疾病以及进行小手术。
