Amanda Fazzalari1,2, Natalie Pozzi3, David Alfego4, Qiming Shi4, Nathaniel Erskine5, Gary Tourony6, Jomol Mathew7, Demetrius Litwin5, Mitchell A Cahan5. 1. Department of Surgery, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA. amanda.fazzalari@umassmed.edu. 2. The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, 56 Franklin St, Waterbury, CT, 06706, USA. amanda.fazzalari@umassmed.edu. 3. The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, 56 Franklin St, Waterbury, CT, 06706, USA. 4. Division of Data Sciences and Technology, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01605, USA. 5. Department of Surgery, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA. 6. Department of Finance, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA, 01655, USA. 7. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01605, USA.
Abstract
BACKGROUND: Nationally, Medicaid enrollees with emergency surgical conditions experience worse outcomes overall when compared with privately insured patients. The goal of this study is to investigate disparities in the treatment of cholecystitis based on insurance type and to identify contributing factors. METHODS: Adults with cholecystitis at a safety-net hospital in Central Massachusetts from 2017-2018 were included. Sociodemographic and clinical characteristics were compared based on Medicaid enrollment status (Medicare excluded). Univariate and multivariate analyses were used to compare the frequency of surgery, time to surgery (TTS), length of stay (LOS), and readmission rates between groups. RESULTS: The sample (n = 203) included 69 Medicaid enrollees (34%), with a mean age of 44.4 years. Medicaid enrollees were younger (p = 0.0006), had lower levels of formal education (high school diploma attainment, p < 0.0001), were more likely to be unmarried (p < 0.0001), Non-White (p = 0.0012), and require an interpreter (p < 0.0001). Patients in both groups experienced similar rates of laparoscopic cholecystectomy, TTS, and LOS; however, Medicaid enrollees experienced more readmissions within 30 days of discharge (30.4% vs 17.9%, p < 0.001). CONCLUSION: Despite anticipated population differences, the treatment of acute cholecystitis was similar between Medicaid and Non-Medicaid enrollees, with the exception of readmission. Further research is needed to identify patient, provider, and/or population factors driving this disparity.
BACKGROUND: Nationally, Medicaid enrollees with emergency surgical conditions experience worse outcomes overall when compared with privately insured patients. The goal of this study is to investigate disparities in the treatment of cholecystitis based on insurance type and to identify contributing factors. METHODS: Adults with cholecystitis at a safety-net hospital in Central Massachusetts from 2017-2018 were included. Sociodemographic and clinical characteristics were compared based on Medicaid enrollment status (Medicare excluded). Univariate and multivariate analyses were used to compare the frequency of surgery, time to surgery (TTS), length of stay (LOS), and readmission rates between groups. RESULTS: The sample (n = 203) included 69 Medicaid enrollees (34%), with a mean age of 44.4 years. Medicaid enrollees were younger (p = 0.0006), had lower levels of formal education (high school diploma attainment, p < 0.0001), were more likely to be unmarried (p < 0.0001), Non-White (p = 0.0012), and require an interpreter (p < 0.0001). Patients in both groups experienced similar rates of laparoscopic cholecystectomy, TTS, and LOS; however, Medicaid enrollees experienced more readmissions within 30 days of discharge (30.4% vs 17.9%, p < 0.001). CONCLUSION: Despite anticipated population differences, the treatment of acute cholecystitis was similar between Medicaid and Non-Medicaid enrollees, with the exception of readmission. Further research is needed to identify patient, provider, and/or population factors driving this disparity.
Entities:
Keywords:
Cholecystitis; Disparities; Emergency general surgery; Medicaid
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