Medicaid and Medicare payer status are associated with worse surgical outcomes in gynecologic oncology.

OBJECTIVE

To compare postoperative outcomes by primary payer status for patients with gynecologic malignancies.

METHODS

We retrospectively reviewed patients who underwent elective surgery for gynecologic malignancies between 2015 and 2019. Patient outcomes were compared by payer status using logistic regression. Sociodemographic and clinical covariates were selected a priori and included age, American Society of Anesthesiologists physical status classification, body mass index, smoking status, malignancy site, surgery type, race, estimated income, marital status, and medical interpreter requirement.

RESULTS

A total of 1894 patients comprised the study sample. In the multivariate model, compared to patients with private insurance, Medicaid and Medicare patients were more likely to mobilize >24 h after surgery (OR 1.9, p < 0.05 and OR 3.2, p < 0.001, respectively), to require ICU admission (OR 4.0, p < 0.05 and OR 5.0, p < 0.05, respectively), and to have longer lengths of stay (OR 1.8, p < 0.05 and OR 2.2, p < 0.001, respectively). Medicaid patients were also more likely to have higher total hospital costs (OR 1.7, p < 0.05). Payer status was not associated with postoperative pain, postoperative opiate use, or 30-day readmission rates.

CONCLUSIONS

Medicaid and Medicare payer status are associated with worse postoperative outcomes in patients with gynecologic malignancies. The poor outcomes of Medicaid patients - a cohort defined by limited income - are noteworthy. The etiology is likely multifactorial, arising from a complex interplay of factors ranging from system issues such as access to care to the unique health status of a population bearing a high burden of disease and socioeconomic adversity.