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Primary payer status, individual patient characteristics, and hospital‐level factors affecting length of stay and total cost of hospitalization in total laryngectomy
Author(s) -
Mehta Vikas,
Flores José M.,
Thompson Richard Will,
Nathan CherieAnn
Publication year - 2017
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24585
Subject(s) - medicaid , medicine , laryngectomy , quartile , odds ratio , confidence interval , emergency medicine , odds , logistic regression , surgery , health care , larynx , economics , economic growth
Background Medicaid and uninsured patients anecdotally incur higher cost and length of stay because of nonmedical, discharge‐related factors. The purpose of this study was to investigate the association between primary payer and length of stay and cost, controlling for comorbidities and complications, in patients undergoing total laryngectomy. Methods The sample included 4128 patients who underwent total laryngectomy in the 2005 to 2010 National Inpatient Sample (NIS). Patients were categorized into 4 subgroups based on payer status: Medicare, Medicaid, uninsured, and private insurance. Using multilevel modeling, we examined differences in length of stay and hospitalization costs. Results The odds of being in the top quartile of length of stay increased for Medicaid patients by 41% (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.03–1.92) compared with privately insured patients. Conclusion After controlling for medical factors, Medicaid patients had increased lengths of stay. Overall costs were highest for those with public insurance, but no difference was seen for the adjusted cost. © 2016 Wiley Periodicals, Inc. Head Neck 39: 311–319, 2017