Uninsured patients have more unplanned surgeries, accrue higher total costs
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Key takeaways:
- Unplanned surgery rates were higher for uninsured patients vs. those with private insurance (72.6% vs. 33.14%).
- Uninsured patients also had more complications and longer hospital stays.
Patients without health insurance experienced higher rates of unplanned surgery, inpatient mortality and complications for access-sensitive conditions that could be treated electively, according to data published in JAMA Surgery.
“While having health insurance is important for a broad range of surgical procedures, it is particularly relevant to access-sensitive surgical conditions,” Shukri H. A. Dualeh, MD, a general surgery resident at Michigan Medicine, and colleagues wrote. “These surgical conditions are ideally treated electively, but when access to surgery is limited, they have a natural course of disease requiring an unplanned operation.”
They continued: “As such, the rate of unplanned vs. elective care for these conditions has been proposed as an indicator of surgical access and a measure to evaluate the implications of health insurance status.”
In a cross-sectional cohort study, researchers investigated the association between insurance status and rates of unplanned surgery among 146,609 patients (mean age, 50.9 years; 50.4% women) who underwent colectomies for cancer (68.3%), ventral hernia repairs (26.5%) or abdominal aortic aneurysm repairs (5.2%) between 2016 and 2020. Most patients underwent elective (60.7%) vs. unplanned (39.9%) surgery.
Researchers reported 70.9% of patients had private health insurance, 19.6% had Medicaid and 5.5% were uninsured, with rates of unplanned surgery varying “significantly” by insurance type (33.14% vs. 51.46% and 72.6%, respectively).
Results also showed uninsured patients experienced higher rates of inpatient mortality (1.29% vs. 0.61%; adjusted OR = 1.18; 95% CI, 1.1-1.25) and complications (19.19% vs. 12.27%; aOR = 1.35; 95% CI, 1.32-1.38) as well as longer hospital stays (7.27 days vs. 5.56 days; absolute difference = 1.7; 95% CI, 1.49-1.91) compared with patients who had private insurance.
Further, total cost for uninsured patients was $22,219 (95% CI, 21,597-22,842) vs. $21,189 (95% CI, 21,026-21,352) for patients with private insurance, an absolute difference of $1,030 (95% CI, 245-1,816).
Regardless of insurance type, researchers noted that patients who underwent unplanned surgery had worse outcomes compared with those who underwent elective surgery.
“Patients without health insurance were more likely than patients with private insurance to undergo unplanned surgery for three access-sensitive conditions that can be treated electively, with worse outcomes and longer hospital stays,” Dualeh and colleagues wrote. “Overall, increasing access to timely care prior to a surgical episode, such as expanding insurance coverage and providing adequate primary care, may close the gap for uninsured patients.”
They concluded: “As interventions to improve surgical care across all insurance types are being implemented, tracking elective vs. unplanned surgery rates for access-sensitive surgical conditions may be a useful measure to assess progress.”
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