C. R. Reed1, M. C. Turner1, M. Talbott1, Z. Sun1, K. Sherman1, C. R. Mantyh1, J. Migaly1 1Duke University Medical Center,Durham, NC, USA
Introduction:
Although stoma reversal following Hartmann’s procedure is associated with improved quality of life, existing reports suggest that reversal rates and timing to reversal are not optimal. Therefore, we aimed to evaluate the impacts of race and insurance coverage on ostomy reversal following Hartmann’s procedure for diverticulitis.
Methods:
The Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (2007-2010) were queried for patients who underwent Hartmann’s procedure in the setting of diverticulitis. Patients who died during their index hospitalization were excluded. Patients were grouped by race and insurance status. After multivariable adjustment for demographic and clinical variables, rate and timing of colostomy takedown at one year were evaluated.
Results:
Among 11,018 patients who underwent a Hartmann’s procedure, 6,900 (63%) patients underwent ostomy reversal at one year, with a median time to reversal of 18 weeks.
Compared to white patients with private insurance, combinations of black race and non-private insurance had reduced likelihood of ostomy reversal at one year (black patients with private insurance: OR: 0.64, 95% CI: 0.44-0.93, p=0.021; white patients with Medicaid: OR: 0.79, 95% CI: 0.67-0.93, p=0.005; black patients with Medicaid: OR: 0.62, 95% CI: 0.43-0.89, p=0.009; black patients with Medicare: OR: 0.33, 95% CI: 0.18-0.59, p<0.001; white patients without insurance: OR: 0.30, 95% CI: 0.24-0.37, p<0.001; white patients with Medicare: OR: 0.29 95% CI: 0.21-0.38, p<0.001; black patients without insurance: OR: 0.24 95% CI: 0.13-0.45, p<0.001).
For patients who underwent ostomy reversal, combinations of black race and non-private insurance also had a delay to reversal compared to white patients with private insurance (white patients with Medicaid: 1.5 weeks 95% CI 0.71-2.4, p<0.001; black patients with private insurance: 1.7 weeks, 95% CI: -0.14-3.5, p=0.07; white patients with Medicare: 2.8 weeks, 95% CI: 1.2-4.4, p=0.001; black patients with Medicaid: 3.4 weeks, 95% CI: 1.3-5.6, p=0.002; white patients without insurance: 3.7 weeks, 95% CI: 2.6-4.8, p<0.001; black patients with Medicare: 3.7 weeks, 95% CI: 0.58-6.9, p=0.02; black patients without insurance: 8.0 weeks, 95% CI: 4.5-11.4, p<0.001).
Conclusion:
Race and insurance coverage have complex, significant interactions with rate and timing of ostomy reversal after Hartmann's procedure for diverticulitis. Black patients and those without private insurance receive suboptimal care compared to white patients with private insurance. These disparities are important to consider for allocation of surgical resources in marginalized communities.
