Maria F Nunez1, Gezzer Ortega2, Lucas G Souza Mota3, Olubode A Olufajo4, Derek W Altema5, Terrence M Fullum6, Daniel Tran7. 1. Research Centers in Minority Institutions Program, Howard University College of Medicine, 520 W Street NW, Rm 436, Washington, DC, 20059, USA; Clive O. Callender, MD Howard-Harvard Health Sciences Outcomes Research Center, Howard University, 2041 Georgia Avenue, NW, Suite 4B-35, Washington, DC, 20060, USA. Electronic address: maria.nunez@howard.edu. 2. Research Centers in Minority Institutions Program, Howard University College of Medicine, 520 W Street NW, Rm 436, Washington, DC, 20059, USA; Clive O. Callender, MD Howard-Harvard Health Sciences Outcomes Research Center, Howard University, 2041 Georgia Avenue, NW, Suite 4B-35, Washington, DC, 20060, USA. Electronic address: gortega1@bwh.harvard.edu. 3. Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA. Electronic address: lucas.souzamota@bison.howard.edu. 4. Research Centers in Minority Institutions Program, Howard University College of Medicine, 520 W Street NW, Rm 436, Washington, DC, 20059, USA; Clive O. Callender, MD Howard-Harvard Health Sciences Outcomes Research Center, Howard University, 2041 Georgia Avenue, NW, Suite 4B-35, Washington, DC, 20060, USA. Electronic address: olubode.olufajo@howard.edu. 5. Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA. Electronic address: derek.altema@bison.howard.edu. 6. Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA; Department of Surgery, Howard University Center for Wellness and Weight Loss Surgery, 2041 Georgia Ave NW, Tower Building 4100B, Washington, DC, 20060, USA. Electronic address: tfullum@howard.edu. 7. Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA; Department of Surgery, Howard University Center for Wellness and Weight Loss Surgery, 2041 Georgia Ave NW, Tower Building 4100B, Washington, DC, 20060, USA. Electronic address: daniel.tran@howard.edu.
Abstract
BACKGROUND: Hernias represent one of the most common surgical conditions with a high-burden on health expenditures. We examined the impact of socioeconomic-status and complexity of presentation among patients in the Emergency Department (ED). METHODS: Retrospective analysis of 2006-2014 data from the Nationwide Emergency Department Sample, identified adult discharges with a diagnosis of inguinal, femoral, and umbilical hernia. Cases were dichotomized: complicated and uncomplicated. Unadjusted and adjusted analyses were used to determine factors that influence ED presentation. RESULTS: Among 264,484 patients included, 73% presented as uncomplicated hernias and were evaluated at urban hospitals (86%). Uncomplicated presentation was more likely in Medicaid (OR 1.56 95%CI1.50-1.61) and uninsured (OR 1.73 95%CI 1.67-1.78), but less likely for patients within the third and fourth MHI quartile (OR 0.82 95%CI 0.80-0.84 and OR 0.77 95%CI 0.75-0.79), respectively. CONCLUSION: Uninsured, publicly-insured, and low-MHI patients were more likely to present to ED with uncomplicated hernias. This finding might reflect a lack of access to primary surgical care for non-urgent surgical diseases.
BACKGROUND:Hernias represent one of the most common surgical conditions with a high-burden on health expenditures. We examined the impact of socioeconomic-status and complexity of presentation among patients in the Emergency Department (ED). METHODS: Retrospective analysis of 2006-2014 data from the Nationwide Emergency Department Sample, identified adult discharges with a diagnosis of inguinal, femoral, and umbilical hernia. Cases were dichotomized: complicated and uncomplicated. Unadjusted and adjusted analyses were used to determine factors that influence ED presentation. RESULTS: Among 264,484 patients included, 73% presented as uncomplicated hernias and were evaluated at urban hospitals (86%). Uncomplicated presentation was more likely in Medicaid (OR 1.56 95%CI1.50-1.61) and uninsured (OR 1.73 95%CI 1.67-1.78), but less likely for patients within the third and fourth MHI quartile (OR 0.82 95%CI 0.80-0.84 and OR 0.77 95%CI 0.75-0.79), respectively. CONCLUSION: Uninsured, publicly-insured, and low-MHIpatients were more likely to present to ED with uncomplicated hernias. This finding might reflect a lack of access to primary surgical care for non-urgent surgical diseases.
Authors: Daniel B Gingold; Rachelle Pierre-Mathieu; Brandon Cole; Andrew C Miller; Joneigh S Khaldun Journal: Am J Emerg Med Date: 2017-01-13 Impact factor: 2.469
Authors: Saral Patel; Abbas Smiley; Cailan Feingold; Bardia Khandehroo; Agon Kajmolli; Rifat Latifi Journal: Int J Environ Res Public Health Date: 2022-08-21 Impact factor: 4.614