MP9-17 UTILIZATION AND OUTCOMES OF INPATIENT SURGERY AT SAFETY-NET HOSPITALS

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2015MP9-17 UTILIZATION AND OUTCOMES OF INPATIENT SURGERY AT SAFETY-NET HOSPITALS Lindsey Herrel, Zaojun Ye, and David Miller Lindsey HerrelLindsey Herrel More articles by this author , Zaojun YeZaojun Ye More articles by this author , and David MillerDavid Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.377AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many worry that funding cuts proposed by the Affordable Care Act (ACA) will compromise the care and outcomes for the vulnerable populations treated in safety-net hospitals (SNHs). In order to anticipate the potential effects of reforms in this area, we examined utilization, outcomes and cost of inpatient surgery at SNH vs non-SNHs prior to implementation of the ACA. METHODS Using data from the Nationwide Inpatient Sample and American Hospital Association Survey, we performed a retrospective cohort study of patients undergoing common inpatient surgeries at SNHs vs non-SNHs from 2007 through 2011. We defined the “safety-net burden” for each hospital based on the proportion of Medicaid and self-pay discharges. We then examined demographic and structural characteristics, as well as the distribution of surgical procedures for SNH (hospitals in the highest quartile of safety-net burden) vs non-SNHs (lowest quartile). For the most common procedures performed in SNH, we also fit multivariable models to compare in-hospital mortality, prolonged length of stay (>90th percentile), and total hospital costs among patients treated at hospitals in the highest vs lowest quartile of safety-net burden. RESULTS SNHs are more frequently large teaching hospitals that treat more low-income, young and minority patients. The distribution of surgical procedures also differs by safety-net status, with more gynecologic (C-section 10.6% of all procedures at SNH vs 5.8% non-SNH, p<0.001) and fewer orthopedic procedures (joint replacement 4.4% vs 9.9%, spinal fusion 4.3% vs 7.1%, p <0.001) performed at SNHs. Across nearly all procedures studied, the adjusted likelihood of inpatient mortality and prolonged length of stay was significantly higher at hospitals with the greatest safety-net burden (Table). We identified no significant cost differences for surgeries in SNH vs non-SNH, with the exception that hysterectomy ($7,040 vs $7,581, p=0.03) and appendectomy ($8,174 vs $8,646, p=0.03) were less expensive at SNHs. CONCLUSIONS Perhaps reflecting their more disadvantaged patient populations, inpatient mortality and LOS outcomes were inferior at SNHs before implementation of the ACA. Further reductions in safety-net funding as a consequence of health care reform may exacerbate these existing disparities. Table 1. Inpatient Procedural Mortality and Prolonged Length of Stay (NIS 2007-2011) Procedure Mortality Prolonged LOS Adjusted SNH OR (95% CI) Adjusted SNH OR (95% CI) Cesarean section 1.67 (0.95-2.96) 1.12 (0.92-1.36) Spinal fusion 1.74 (1.35-2.23) 1.49 (1.22-1.82) Hysterectomy 1.64 (1.19-2.25) 0.81 (0.66-1.00) Joint Replacement 1.29 (1.10-1.53) 1.34 (1.15-1.56) Lower Extremity Open Reduction Internal Fixation 1.33 (1.18-1.49) 1.70 (1.47-1.97) Cholecystectomy 1.52 (1.32-1.76) 1.30 (1.13-1.50) Colorectal Resection 1.36 (1.24-1.50) 1.19 (1.08-1.32) Appendectomy 1.57 (1.27-1.95) 1.13 (1.04-1.23) Coronary Artery Bypass 1.21 (1.06-1.38) 1.30 (1.10-1.53) Adjusted for age, race, admission type, payer, income, comorbidities. Referent group is non-SNH. Prolonged LOS: >90th percentile LOS for specified procedure. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e108 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lindsey Herrel More articles by this author Zaojun Ye More articles by this author David Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...