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Morbidity and mortality of radical prostatectomy differs by insurance status
Author(s) -
Trinh QuocDien,
Schmitges Jan,
Sun Maxine,
Sammon Jesse,
Shariat Shahrokh F.,
Zorn Kevin,
Sukumar Shyam,
Bianchi Marco,
Perrotte Paul,
Graefen Markus,
Rogers Craig G.,
Peabody James O.,
Me Mani,
Karakiewicz Pierre I.
Publication year - 2011
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.26475
Subject(s) - medicine , medicaid , confounding , prostatectomy , logistic regression , odds ratio , blood transfusion , emergency medicine , odds , demography , health care , prostate cancer , cancer , sociology , economics , economic growth
BACKGROUND: Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short‐term RP outcomes. METHODS: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003‐2007). We tested the rates of blood transfusions, extended length of stay, intraoperative and postoperative complications, as well as in‐hospital mortality, stratified according to insurance status. Multivariable logistic regression analyses, fitted with general estimation equations for clustering among hospitals, adjusted for confounding factors. RESULTS Overall, 61,167 RPs were identified. Of those, private insurance accounted for the majority of cases (n = 41,312, 67.5%), followed by Medicare (n = 18,759, 30.7%) and Medicaid (n = 1096, 1.8%). Insurance status other than private was associated with higher rates of blood transfusions ( P < .001), higher overall postoperative complication rates ( P < .001), higher rates of hospital stay above the median ( P < .001), as well as higher in‐hospital mortality ( P = .01). In multivariable analyses, compared with patients with private insurance, Medicaid patients had higher rates of blood transfusion (odds ratio [OR] = 1.45, P < .001), length of stay beyond the median (OR = 1.61, P < .001) postoperative complications (OR= 1.24, P = .02), and in‐hospital mortality (OR = 4.91, = .01). Similarly, Medicare patients had higher rates of blood transfusions (OR = 1.21, P < .001), overall postoperative complications (OR = 1.17, P ×< .001) and length of stay beyond the median (OR = 1.25, P < .001). CONCLUSIONS: Even after adjusting for confounding factors, patients with private insurance have better outcomes than their counterparts with nonprivate insurance. Cancer 2012;. © 2011 American Cancer Society.