Insurance Status, an Important Predictor of Oral Cancer Surgery Outcomes

Abstract

Patients without insurance, or using Medicaid, generally have a lower socioeconomic status. They have less access to screening and regular medical care, resulting in later diagnosis of oral cancer. This study examined the association between insurance status and the likelihood of complications after head and neck cancer surgery. A retrospective cross-sectional study was implemented to determine whether patients' insurance status is associated with increased complications and length of stay after oral cancer surgery. Patients were grouped into 4 cohorts: 1) private insurance, 2) Medicare, 3) Medicaid, and 4) uninsured. Patients were stratified further to consider age, gender, initial staging, pre-existing comorbidities, and social history. Data were analyzed with χ(2) test, 1-way analysis of variance, odds ratios, and binary logistic regression. This study consisted of 89 surgically treated patients. The uninsured and Medicaid groups had the highest incidence of postoperative complications. Uninsured patients, followed by the Medicare cohort, were the most likely to have an extended length of stay. Uninsured and Medicaid patients are at increased probability for major and minor complications after head and neck cancer surgery. Uninsured patients also showed the greatest tendency for a prolonged length of hospital stay. This could reflect their lack of preventive care, increased use of tobacco and alcohol, presentation with more advanced disease, and delays in initiating treatment.