Ayesha Farooq1, Anghela Z Paredes1, Katiuscha Merath1, J Madison Hyer1, Rittal Mehta1, Kota Sahara1, Diamantis I Tsilimigras1, Amika Moro1, Lu Wu1, Jordan Cloyd1, Aslam Ejaz1, Timothy M Pawlik2,3. 1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. 2. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Columbus, OH, USA. tim.pawlik@osumc.edu. 3. Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA. tim.pawlik@osumc.edu.
Abstract
INTRODUCTION: Safety-net hospitals are critical to the US health system as they provide care to vulnerable patients. The effect of hospital safety-net burden on patient outcomes in hepatopancreaticobiliary (HPB) surgery was examined. METHODS: Discharge data between 2004 and 2014 from the National Inpatient Sample were utilized. Hospitals with a safety-net burden were divided into tertiles: low (LBH) (< 13.6%), medium (MBH) (13.6-33.3%), and high (HBH) (> 33.3%). The association of hospital safety-net burden with complications, in-hospital mortality, never events, and costs were defined. RESULTS: Nearly 5% of the analytic cohort (n = 65,032) had surgery at a HBH. Patients treated at HBH were younger (median age, HBH 55 years vs LBH 62 years; p < 0.001), black or Hispanic (HBH 40.5% vs LBH 12.7%; p < 0.001), and of lowest income quartile (HBH 38.4% vs LBH 19.6%; p < 0.001). One-third of patients at HBH experienced a complication compared with only a quarter of patients at LBH (p < 0.001). HBH had higher rates of in-hospital mortality (HBH 6.5% vs. LBH 2.8%; p < 0.001), never events (HBH 5.4% vs. LBH 1.4%; p < 0.001), and a higher cost of surgery (HBH $30,716 vs. LBH $28,054; p < 0.001). CONCLUSION: Perioperative outcomes were worse at HBH, highlighting that efforts are needed to improve their delivery of care.
INTRODUCTION: Safety-net hospitals are critical to the US health system as they provide care to vulnerable patients. The effect of hospital safety-net burden on patient outcomes in hepatopancreaticobiliary (HPB) surgery was examined. METHODS: Discharge data between 2004 and 2014 from the National Inpatient Sample were utilized. Hospitals with a safety-net burden were divided into tertiles: low (LBH) (< 13.6%), medium (MBH) (13.6-33.3%), and high (HBH) (> 33.3%). The association of hospital safety-net burden with complications, in-hospital mortality, never events, and costs were defined. RESULTS: Nearly 5% of the analytic cohort (n = 65,032) had surgery at a HBH. Patients treated at HBH were younger (median age, HBH 55 years vs LBH 62 years; p < 0.001), black or Hispanic (HBH 40.5% vs LBH 12.7%; p < 0.001), and of lowest income quartile (HBH 38.4% vs LBH 19.6%; p < 0.001). One-third of patients at HBH experienced a complication compared with only a quarter of patients at LBH (p < 0.001). HBH had higher rates of in-hospital mortality (HBH 6.5% vs. LBH 2.8%; p < 0.001), never events (HBH 5.4% vs. LBH 1.4%; p < 0.001), and a higher cost of surgery (HBH $30,716 vs. LBH $28,054; p < 0.001). CONCLUSION: Perioperative outcomes were worse at HBH, highlighting that efforts are needed to improve their delivery of care.
Authors: Rittal Mehta; Diamantis I Tsilimigras; Anghela Z Paredes; Kota Sahara; Mary Dillhoff; Jordan M Cloyd; Aslam Ejaz; Susan White; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2020-02-27 Impact factor: 5.344
Authors: Annabelle L Fonseca; Hamza Khan; Krista R Mehari; Deepa Cherla; Martin J Heslin; Fabian M Johnston Journal: Ann Surg Oncol Date: 2022-01-23 Impact factor: 5.344