P. Deol2, J. Sipko2, A. Kumar2, A. Tsalatsanis2, F. Velez-Cubian2, C. Moodie1, J. Garrett1, J. Fontaine1,2, E. M. Toloza1,2 1Moffitt Cancer Center,Tampa, FL, USA 2University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction: Underinsured patients reportedly are less likely to undergo surgical treatment for lung cancer. We studied the effect of insurance type on patient outcomes following minimally invasive pulmonary lobectomy.
Methods: We retrospectively analyzed patients who consecutively underwent robotic-assisted pulmonary lobectomy by one surgeon over an 80-month period. Perioperative outcomes as well as intraoperative and postoperative complications were noted. Disposition at discharge after surgery (favorable, e.g. transfer to home with self-care or home health nursing and/or physical therapy, vs. unfavorable, e.g. long-term acute care or rehabilitation facility, hospice, or expired) and 5-year overall survival (5-yr OS) were also recorded. We used Pearson Chi-square (X2), Analysis of Variance (ANOVA), and Kruskal-Wallis test to compare variables, and Cox regression for survival analysis, with statistical significance established at P<0.05.
Results: Of 433 study patients, 107 patients had private insurance (mean age 57.5 yr), 118 had public insurance [Medicare or Medicaid (mean age 70.3 yr)], 196 patients had combination insurance plans [Medicare plus a privately supplied supplemental plan (mean age 71.8 yr; P<0.001)], and 12 patients had no insurance (excluded due to low sample size). There were more current smokers in the public insurance group, more former smokers in the combination insurance group, and more nonsmokers in the private insurance group (P=0.03). There were more comorbidities in the public and combination insurance groups vs. the private insurance group, including gastroesophageal reflux disease (P=0.003), hypertension (P=0.01), and hyperlipidemia (P<0.001). The groups had no differences in tumor size or pathologic stage. There were a higher rate of intraoperative conversions to open lobectomy in the private and public insurance groups vs. the combination insurance group (P=0.001). The private and combination insurance groups had more cases of favorable disposition at discharge after surgery compared to the public insurance group (P<0.001). Multi-variable regression analyses identified private insurance type as an independent predictor of favorable disposition at discharge [public vs. private plan; odds ratio (OR): 0.43 [95% confidence interval (CI): 0.22 – 0.85], P=0.02] as well as 5-yr OS [(combination vs. private plan; hazard ratio (HR): 2.68 (95% CI: 1.26 – 5.67), P=0.01), (public vs. private plan; HR: 2.84 (95% CI: 1.37 – 5.89), P=0.01)].
Conclusions: Although public or combination insurance type was associated with greater risk of all-cause 5-yr mortality, and public insurance type was associated with overall conversion to open lobectomy and less favorable disposition at discharge after surgery, insurance type was not associated with increased intraoperative complications, hospital length of stay, or in-hospital mortality following minimally invasive robotic-assisted pulmonary lobectomy.