I. V. Bonner1, C. Heron1, Q. W. Myers1, K. Hazel1, D. M. Garofalo1, C. G. Velopulos1 1University of Colorado Anschutz Medical Campus, School Of Medicine, Department Of Surgery, Aurora, CO, USA
Introduction: The chances of chronic pain, hernia recurrence, and increased length of stay following hernia repair have been associated with socioeconomic factors of sex, race, and income. While insurance status has been correlated with likelihood of emergent hernia repair, the relationship between insurance status, other demographic variables and outcomes has not been thoroughly characterized when considering only emergent operations. Many believe that granting some type of insurance coverage will solve the problem of patients presenting emergently instead of electively. This study aims to examine if social characteristics and outcomes are different for insured patients undergoing an emergent operation, or if prior noted differences are related directly to upstream factors that affect the urgency of the procedure.
Methods: We created a database from hospital billing data of patients who underwent emergency surgeries that have an elective counterpart, and then extracted the codes for inguinal, epigastric/ventral, or incisional hernia. We then completed manual chart review of the following variables: demographics, chronicity of disease prior to surgery, insurance status, prior ED or PCP visits for the diagnosis, and outcomes such as discharge disposition. Insurance status was dichotomized to insured or uninsured to compare the two groups. We used chi-square tests for categorial variables, Mann-Whitney U tests of association for continuous variables, and the Kruskal-Wallis test for continuous variables with more than two categories.
Results: We had 98 patients meeting criteria. While uninsured patients were significantly younger (32.6% of the insured population was Medicare), there were no other significant differences between insurance types, and all outcomes were similar between insured and uninsured patients. Prior PCP and/or ED visits, and charges were similar. A sensitivity analysis was done with insurance types separated, and there was no difference. There is a difference in chronicity between insured and uninsured patients in our sample which was driven by a greater number of uninsured patients having the disease process for more than one year.
Conclusion: We found no independent associations between insurance status and the characteristics and outcomes for patients who had emergency hernia repair surgery. This suggests that just having insurance is not sufficient to mitigate the multiple factors that lead to disparities in access and outcomes for surgical patients. These other factors drive the conversion of potentially elective surgery toward emergent surgery, indicating a need to address potentially modifiable barriers to elective surgical presentation.
