M. J. Adair1, S. Markowiak1, M. Baldawi1, C. Taylor1, A. Aldhaheri1, C. Das1, W. Qu1, M. Nazzal1, S. Pannell1 1University Of Toledo Medical Center,Department Of Surgery,Toledo, OH, USA
INTRODUCTION
Hartmann’s procedure is traditionally performed to treat colonic obstruction or perforation. Using a national database, the aim of this study was to compare patients with different types of health insurance (different payer sources) for short-term postoperative outcomes after Hartmann's procedure.
METHODS
From the Natioinal Inpatient Sample (NIS) database, patients who underwent elective or urgent Hartmann's procedure for the time period between 2008 and 2014 were included in this study. After adjustment for demographics and comorbidites, health insurance types were compared for in-hospital mortality, post-perative complications, length of hospital stay, and total hospital cost. Univariate analysis was performed using Chi-square test, two sample t-test and Mann-Whitney U test. Multiple logistic regression was utilized for the multivariate analysis.
RESULTS
A total of 9,836 patients were included in this study. The average age of patients (mean ±SD) was 65.6±15.4 years old. Out of these patients, 4574 (46.5%) were males and 7667 (78%) were White. Overall in-hospital mortality rate was 11.9% (n=1169). The median hospital lenght of stay was 12 days and the median total hospital cost was US$104,635. Using multivariate analysis, we foud that Medicare and Medicaid patients had significantly higher mortality rate than private insurance patients (16.5% and 7.6% versus 5.9%, respectively. P<0.001). Medicare and Medicaid patients also had a longer hospital length of stay in comparison to Private insurance patients (13 days and 14 days versus 11 days, respectively. P<0.001).
CONCLUSION
Following Hartmann’s procedure, Medicare and Medicaid patients have a higher risk of mortality and longer total hospital length of stay in comparison to those with private insurance. A strong consideration of possible undiagnosed comorbidities, delayed presentation or inadequate prior management must be undertaken when treating these patients. We also recommend performing further research to fully analyze all the potential factors that can influence outcomes after Hartmann’s Procedure.