M. F. Nunez1, G. Ortega1, L. G. Souza Mota3, I. Yi3, S. Timberline3, E. S. Bauer1, T. M. Fullum1,2, D. Tran1,2 1Howard University College Of Medicine,Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center,Washington, DC, USA 2Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 3Howard University College Of Medicine,Washington, DC, USA
Introduction:
Hernia repair is one of the most common elective procedures performed worldwide. Most hernias are treated and managed in an outpatient setting. Our objective was to determine the characteristics and relationship between demographics, socioeconomic status, insurance status, and complexity at presentation among a national sample of emergency department patients.
Methods:
A retrospective analysis of 2006–2014 data from the Nationwide Emergency Department Sample, were queried to identify adult patients presenting to the emergency department with a diagnosis of inguinal, femoral, and umbilical hernia. Cases were dichotomized according with the type of presentation: complicated or acute (with gangrene and/or obstruction) and uncomplicated hernia. The two groups were compared with unadjusted and adjusted analyses to determine the socioeconomic factors that influence presentation and admission.
Results:
A total of 597,246 patients were included, the majority were male (73%), and had a mean age of 55 years. Most patients had Medicare (37%), followed by Private insurance (27%), uninsured (20%), and Medicaid (16%). With respect to median household income (MHI) the majority were in the lowest income quartile (32%). Most were treated at an urban hospital (86%), and most had uncomplicated hernias (84%). Of those that were uncomplicated most were male (74%), the majority had Medicare (34%), and 33% were in the lowest income quartile. Most of the complicated hernias, were male (66%), the majority had Medicare (51%), and 27% were in the lowest quartile. Uninsured patients made up 22% of the uncomplicated hernia group vs 12% of the complicated hernia group (p= <0.05). Of the complicated hernia group, 75% were admitted. On adjusted analysis, there was a higher likelihood of presenting as uncomplicated hernia for patients with Medicaid (OR 1.45 95%CI 1.41- 1.50), uninsured (OR 1.54 95%CI 1.50-1.58), and Medicare (OR 1.02 95%CI 0.99-1.05). And less likely if they were in the third and fourth MHI quartile (OR 0.86 95%CI 0.84-0.88 and OR 0.77 95%CI 0.75-0.78), respectively. Among patients who were admitted, the likelihood of presenting with a complicated hernia was higher if the patient was uninsured (OR 1.34 95%CI 1.28-1.40) and was lower for Medicare (OR 0.73 95%CI 0.69-0.76) and Medicaid (OR 0.81 95%CI 0.84-0.88).
Conclusion:
Uninsured and publicly insured patients were more likely to present to emergency departments with an uncomplicated hernia. This may represent a lack of access to primary surgical care for non-urgent surgical diseases. However, among patients already admitted, those with public insurance were less likely to have complicated hernias while uninsured patients were more likely to have complicated hernias.