Erin C Hall1, Chaoyi Zheng2, Russell C Langan1, Lynt B Johnson1, Nawar Shara3, Waddah B Al-Refaie4. 1. Department of Surgery, MedStar-Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007, USA; MedStar-Georgetown Surgical Outcomes Research Center, 3800 Reservoir Road, Washington, DC, 20007, USA. 2. MedStar-Georgetown Surgical Outcomes Research Center, 3800 Reservoir Road, Washington, DC, 20007, USA. 3. MedStar-Georgetown Surgical Outcomes Research Center, 3800 Reservoir Road, Washington, DC, 20007, USA; MedStar Health Research Institute, University Town Center, 6525 Belcrest Road #700, Hyattsville, MD, 20782, USA. 4. Department of Surgery, MedStar-Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007, USA; MedStar-Georgetown Surgical Outcomes Research Center, 3800 Reservoir Road, Washington, DC, 20007, USA; MedStar Health Research Institute, University Town Center, 6525 Belcrest Road #700, Hyattsville, MD, 20782, USA. Electronic address: Waddah.b.al-refaie@gunet.georgetown.edu.
Abstract
BACKGROUND: Medicaid beneficiaries do not have equal access to high-volume centers for complex surgical procedures. We hypothesize there is a large Medicaid Gap between those receiving emergency general vs complex surgery at the same hospital. METHODS: Using the Nationwide Inpatient Sample, 1998 to 2010, we identified high-volume pancreatectomy hospitals. We then compared the percentage of Medicaid patients receiving appendectomies vs pancreatectomies at these hospitals. Hospital characteristics associated with increased Medicaid Gap were evaluated using generalized estimating equation models. RESULTS: A total of 602 hospital-years of data from 289 high-volume pancreatectomy hospitals were included. Median percentages of Medicaid appendectomies and pancreatectomies were 12.1% (interquartile range: 5.8% to 19.8%) and 6.7% (interquartile range: 0% to 15.4%), respectively. Hospitals that performed greater than or equal to 40 pancreatic resections per year had higher odds of having significant Medicaid Gap (odds ratio 2.3, 95% confidence interval 1.1 to 5.0). CONCLUSIONS: Gaps exist between the percentages of Medicaid patients receiving emergency general surgery vs more complex surgical care at the same hospital and may be exaggerated in hospitals with very high volume of complex elective surgeries.
BACKGROUND: Medicaid beneficiaries do not have equal access to high-volume centers for complex surgical procedures. We hypothesize there is a large Medicaid Gap between those receiving emergency general vs complex surgery at the same hospital. METHODS: Using the Nationwide Inpatient Sample, 1998 to 2010, we identified high-volume pancreatectomy hospitals. We then compared the percentage of Medicaid patients receiving appendectomies vs pancreatectomies at these hospitals. Hospital characteristics associated with increased Medicaid Gap were evaluated using generalized estimating equation models. RESULTS: A total of 602 hospital-years of data from 289 high-volume pancreatectomy hospitals were included. Median percentages of Medicaid appendectomies and pancreatectomies were 12.1% (interquartile range: 5.8% to 19.8%) and 6.7% (interquartile range: 0% to 15.4%), respectively. Hospitals that performed greater than or equal to 40 pancreatic resections per year had higher odds of having significant Medicaid Gap (odds ratio 2.3, 95% confidence interval 1.1 to 5.0). CONCLUSIONS: Gaps exist between the percentages of Medicaid patients receiving emergency general surgery vs more complex surgical care at the same hospital and may be exaggerated in hospitals with very high volume of complex elective surgeries.
Authors: Michael T Halpern; Melissa A Romaire; Susan G Haber; Florence K Tangka; Susan A Sabatino; David H Howard Journal: Cancer Date: 2014-08-25 Impact factor: 6.860
Authors: Diane A Schwartz; Xuan Hui; Eric B Schneider; Mays T Ali; Joseph K Canner; William R Leeper; David T Efron; Elliot Haut; Elliot R Haut; Catherine G Velopulos; Timothy M Pawlik; Adil H Haider Journal: Surgery Date: 2014-06-19 Impact factor: 3.982
Authors: Nicholas D Andersen; J Matthew Brennan; Yue Zhao; Judson B Williams; Matthew L Williams; Peter K Smith; John E Scarborough; G Chad Hughes Journal: Circ Cardiovasc Qual Outcomes Date: 2014-04-08
Authors: Al'a Abdo; Quoc-Dien Trinh; Maxine Sun; Jan Schmitges; Marco Bianchi; Jesse Sammon; Shahrokh F Shariat; Shyam Sukumar; Kevin Zorn; Claudio Jeldres; Paul Perrotte; Craig G Rogers; James O Peabody; Mani Menon; Pierre I Karakiewicz Journal: Int Urol Nephrol Date: 2011-09-06 Impact factor: 2.370
Authors: Manila Jindal; Chaoyi Zheng; Humair S Quadri; Chukwuemeka U Ihemelandu; Young K Hong; Andrew K Smith; Vikas Dudeja; Nawar M Shara; Lynt B Johnson; Waddah B Al-Refaie Journal: J Am Coll Surg Date: 2017-04-14 Impact factor: 6.113
Authors: Victoria A Marks; Walter R Hsiang; James Nie; Patrick Demkowicz; Waez Umer; Afash Haleem; Bayan Galal; Irene Pak; Dana Kim; Michelle C Salazar; Elizabeth R Berger; Daniel J Boffa; Michael S Leapman Journal: JAMA Netw Open Date: 2022-07-01