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The impact of hospital safety‐net burden on mortality and readmission after CABG surgery
Author(s) -
Hoyler Marguerite M.,
Tam Christopher W.,
Thalappillil Richard,
Jiang Silis,
Ma Xiaoyue,
Lui Briana,
White Robert S.
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14738
Subject(s) - medicine , underinsured , medicaid , emergency medicine , logistic regression , odds ratio , perioperative , odds , multivariate analysis , retrospective cohort study , univariate analysis , demographics , hospital readmission , health care , surgery , health insurance , demography , sociology , economics , economic growth
Abstract Background and Aim Safety‐net hospitals (SNHs) serve high proportions of uninsured and Medicaid patients. Data conflict as to the impact of hospital safety‐net status on perioperative complications. Our goal was to assess the effect of hospital safety‐net burden on mortality and readmission following coronary artery bypass graft (CABG) surgery. Methods A retrospective analysis was performed using five State Inpatient Databases (2007‐2014) for isolated CABG surgery. High, medium, and low burden hospitals were those with the highest, middle, and lowest tertiles of uninsured and Medicaid admissions, respectively. We compared patient demographics and hospital characteristics by safety‐net status. Multivariable logistic regression models assessed adjusted odds of in‐hospital mortality and 30‐ and 90‐day readmission. Results About 304 080 patients were included in our analysis. On univariate analysis, high burden hospitals had higher inpatient mortality (2.06% vs 1.71%; P < .001) and 30 day‐ (16.3% vs 15.3%; P < .001) and 90‐day readmission rates (24.6% vs 23.0%; P < .001). On multivariate analysis, high‐burden status was not associated with significantly increased adjusted odds of inpatient mortality (OR, 1.047; 95% CI, 0.878‐1.249), or readmission at 30 (OR, 1.035; 95% CI, 0.958‐1.118) or 90 days (OR, 1.040; 95% CI, 0.968‐1.117). Conclusion SNHs do not have worse mortality and readmission outcomes following CABG, after adjusting for patient and hospital characteristics. These findings are reassuring regarding the quality of cardiac surgery care provided to underinsured patient groups. More research is needed to further elucidate trends in outcomes.