Center for Abdominal Core Health, Department of Surgery, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA.
College of Medicine, Ohio State University Wexner Medical Center, 181 Taylor Avenue, 11th Floor, Suite 1102A, Columbus, OH, 43203, USA.
Surg Endosc. 2022 Dec;36(12):9416-9423. doi: 10.1007/s00464-022-09287-7. Epub 2022 May 18.
Access to care and barriers to achieving health equity remain persistent and prevailing issues in the USA, particularly for low socioeconomic (L-SES) populations. Previous studies have shown that public insurance (a surrogate marker for L-SES) is an independent predictor of emergent hernia repair. However, the impact of insurance type on postoperative healthcare utilization, including emergency department (ED) care, following ventral hernia repair (VHR) remains unknown.
The 2013-2020 Abdominal Core Health Quality Collaborative (ACHQC) database was used to identify patients aged 18-64 undergoing ventral hernia repair (VHR) who had private or Medicaid insurance. Patients with no health insurance were also included. Using insurance type, the cohort was divided into three groups: private, public (Medicaid), and uninsured (self-pay). Multivariate logistic regression analyses were used to assess the impact of insurance type on emergency department (ED) utilization, postoperative complications, and readmission.
A total of 17,036 patients undergoing VHR were included in the study, out of which 13,980 (85.8%) had private insurance, 2,451 (8.4%) had public, and 605 (5.8%) were uninsured. Following adjustment for demographics (age, gender, race), comorbidities (hypertension, diabetes, smoking), and clinical characteristics (emergent procedure, ASA class, surgical approach), public insurance was associated with 1.7 times greater odds of returning to the emergency department (ED) within 30 days of surgery compared to private insurance (95% CI 1.4, 2.0; p = 0.01). Public insurance or being uninsured was also associated with increased odds of experiencing any postoperative complications compared to those who were privately insured (public: OR 1.3, p < 0.01; self-pay: OR 1.67, p < 0.01).
Our study demonstrates that public and self-pay insurance are associated with increased emergency department (ED) utilization and worse postoperative outcomes compared to those with private insurance. In an effort to promote health equity, healthcare providers need to assess how parameters beyond physical presentation may impact a patient's health.
在美国，获得医疗服务和实现健康公平的障碍仍然是持续存在且普遍存在的问题，尤其是对于社会经济地位较低（L-SES）的人群。先前的研究表明，公共保险（L-SES 的替代指标）是急诊疝修补术的独立预测因子。然而，保险类型对腹疝修补术（VHR）后医疗保健利用的影响，包括急诊部（ED）护理，尚不清楚。
使用 2013-2020 年腹部核心健康质量协作（ACHQC）数据库，确定接受 VHR 治疗的 18-64 岁的患者，这些患者拥有私人或医疗补助保险。无健康保险的患者也包括在内。根据保险类型，队列分为三组：私人、公共（医疗补助）和无保险（自付）。多变量逻辑回归分析用于评估保险类型对急诊部（ED）利用、术后并发症和再入院的影响。
共有 17036 名患者接受了 VHR 治疗，其中 13980 名（85.8%）有私人保险，2451 名（8.4%）有公共保险，605 名（5.8%）无保险。在调整了人口统计学因素（年龄、性别、种族）、合并症（高血压、糖尿病、吸烟）和临床特征（急诊手术、ASA 分级、手术入路）后，与私人保险相比，公共保险与 30 天内返回急诊部的几率增加了 1.7 倍（95%CI 1.4, 2.0;p=0.01）。与私人保险相比，公共保险或无保险也与经历任何术后并发症的几率增加相关（公共保险：OR 1.3，p<0.01；自付保险：OR 1.67，p<0.01）。
我们的研究表明，与私人保险相比，公共保险和自付保险与急诊部（ED）就诊率增加和术后结果恶化相关。为了促进健康公平，医疗保健提供者需要评估超出身体表现的参数如何影响患者的健康。
