医疗补助扩张对腹部手术发病率、死亡率和医院再入院率的影响。
Impact of Medicaid Expansion on Abdominal Surgery Morbidity, Mortality, and Hospital Readmission.
机构信息
Department of Surgery, University of Virginia, Charlottesville, Virginia; Department of Surgery, Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia; Virginia Surgical Quality Collaborative, Charlottesville, Virginia.
Department of Surgery, University of Virginia, Charlottesville, Virginia.
出版信息
J Surg Res. 2023 Nov;291:586-595. doi: 10.1016/j.jss.2023.06.047. Epub 2023 Aug 2.
INTRODUCTION
Medicaid expansion's (ME) impact on postoperative outcomes after abdominal surgery remains poorly defined. We aimed to evaluate ME's effect on surgical morbidity, mortality, and readmissions in a state that expanded Medicaid (Virginia) compared to a state that did not (Tennessee) over the same time period.
METHODS
Virginia Surgical Quality Collaborative (VSQC) American College of Surgeons National Surgical Quality Improvement Program data for Medicaid, uninsured, and private insurance patients undergoing abdominal procedures before Virginia's ME (3/22/18-12/31/18) were compared with post-ME (1/1/19-12/31/19), as were corresponding non-ME state Tennessee Surgical Quality Collaborative (TSQC) data for the same 2018 and 2019 time periods. Postexpansion odds ratios for 30-d morbidity, 30-d mortality, and 30-d unplanned readmission were estimated using propensity score-adjusted logistic regression models.
RESULTS
In Virginia, 4753 abdominal procedures, 2097 pre-ME were compared to 2656 post-ME. In Tennessee, 5956 procedures, 2484 in 2018 were compared to 3472 in 2019. VSQC's proportion of Medicaid population increased following ME (8.9% versus 18.8%, P < 0.001) while uninsured patients decreased (20.4% versus 6.4%, P < 0.001). Post-ME VSQC had fewer 30-d readmissions (12.2% versus 6.0%, P = 0.013). Post-ME VSQC Medicaid patients had significantly lower probability of morbidity (-8.18, 95% confidence interval: -15.52 ∼ -0.84, P = 0.029) and readmission (-6.92, 95% confidence interval: -12.56 ∼ -1.27, P = 0.016) compared to pre-ME. There were no differences in probability of morbidity or readmission in the TSQC Medicaid population between study periods (both P > 0.05); there were no differences in mortality between study periods in VSQC and TSQC patient populations (both P > 0.05).
CONCLUSIONS
ME was associated with decreased 30-d morbidity and unplanned readmissions in the VSQC. Data-driven policies accounting for ME benefits should be considered.
介绍
医疗补助计划（Medicaid expansion，ME）对腹部手术后的术后结果的影响仍未明确界定。我们旨在评估在同一时期内，弗吉尼亚州（Virginia）实施医疗补助计划（Medicaid expansion，ME）与田纳西州（Tennessee）未实施 ME 相比，ME 对手术发病率、死亡率和再入院率的影响。
方法
弗吉尼亚州外科质量协作（Virginia Surgical Quality Collaborative，VSQC）美国外科医师学会国家外科质量改进计划（American College of Surgeons National Surgical Quality Improvement Program）数据显示，在弗吉尼亚州 ME 实施前（2018 年 3 月 22 日至 12 月 31 日）， Medicaid、无保险和私人保险患者接受腹部手术，与 ME 实施后（2019 年 1 月 1 日至 12 月 31 日）相比，同时期非 ME 州田纳西州外科质量协作（Tennessee Surgical Quality Collaborative，TSQC）数据也进行了比较。使用倾向评分调整的逻辑回归模型估计术后 30 天发病率、30 天死亡率和 30 天非计划性再入院的术后扩展比值比。
结果
在弗吉尼亚州，4753 例腹部手术中，2097 例为 ME 前，2656 例为 ME 后。在田纳西州，5956 例手术中，2018 年有 2484 例，2019 年有 3472 例。ME 后，VSQC 的 Medicaid 人群比例增加（8.9%对 18.8%，P <0.001），而无保险患者减少（20.4%对 6.4%，P <0.001）。ME 后 VSQC 的 30 天再入院率较低（12.2%对 6.0%，P =0.013）。ME 后 VSQC 的 Medicaid 患者发病率（-8.18，95%置信区间：-15.52-0.84，P =0.029）和再入院率（-6.92，95%置信区间：-12.56-1.27，P =0.016）的可能性显著降低。在研究期间，TSQC Medicaid 人群的发病率和再入院率的可能性均无差异（均 P >0.05）；VSQC 和 TSQC 患者人群的死亡率在研究期间均无差异（均 P >0.05）。
结论
ME 与 VSQC 中 30 天发病率和非计划性再入院率降低有关。应考虑基于 ME 益处的数据驱动政策。
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