F. S. Park1, D. Breziner1, J. Hoyos1, K. O. Manzanarez-Felix1, C. D. Yang1, J. C. Pang1, A. M. Ruiz3, C. A. Alvarez2, L. Y. Swentek2, T. Chin2 1University Of California – Irvine, School Of Medicine, Irvine, CA, USA 2University Of California – Irvine, Division Of Trauma, Burns And Surgical Critical Care, Department Of Surgery, Orange, CA, USA 3Huntingon Memorial, Department Of Surgery, Pasadena, CA, USA
Introduction:
Disparities secondary to underinsurance present throughout the surgical care continuum. Community free clinics are uniquely prepared to provide healthcare services to the medically underserved, but surgery often falls outside the scope of care. We report a free clinic-ambulatory surgical center partnership delivering free surgical care.
Methods:
Retrospective chart review was conducted on consecutive adult patients receiving free surgical services from March 2016 through September 2021. Patients were seen in a free clinic pre- and postoperatively while surgery was performed in an ambulatory surgery center. Primary outcomes of interest included postoperative complications and quality of life, the latter of which we assessed via phone survey in English and Spanish to consenting patients. Questions were adapted from the VR-12 and modified PROMIS questionnaires and evaluated postoperative pain, physical health, and emotional health.
Results:
Of 142 patients, 57.0% were female, 95.1% identified as Hispanic, 86.6% reported their primary language as Spanish, and 73.2% were uninsured. Procedures were classified as endoscopic (52.8%), general (22.5%), urologic/gynecologic (17.6%), mass excision (3.5%), and ophthalmologic/orthopedic (3.5%). Pathological diagnoses from common procedures included colorectal adenocarcinoma (n=1), cervicovaginal dysplasia/metaplasia (n=4), and basal cell carcinoma (n=1). Mean waitlist time was 93.8±138.4 days. Mean Area Deprivation Index (ADI) score was 24.3±19.6 by national percentile. The rate of postoperative complications among patients with successful follow-up (n=120) was 7.5% and included bacterial (n=4) or fungal (n=1) infection, wound dehiscence (n=2), and recurrent uterovaginal prolapse (n=2). Postoperative complication rates were not associated with sex, national ADI, or time on waitlist (P>0.05). The postoperative phone survey had a 49.2% response rate. Of these respondents (n=70), 58.6% reported general improvement in physical health and 51.4% reported general improvement in emotional health. 30.0% of respondents reported significant new-onset pain after their surgery. Primary spoken language, insurance status, age, BMI, waitlist time, and national ADI were not associated with general improvement in physical health, emotional health, or ratings of postoperative pain (P>0.05).
Conclusion:
Free clinic-ambulatory surgical center partnerships may provide safe and timely surgical care to underinsured patients with high satisfaction rates. Most patients experienced an improvement in quality of physical and emotional health after free surgery. Areas of possible improvement are minimizing preoperative waitlist time and improving postoperative follow up. Further studies are warranted to elucidate cost-benefit of free clinic-ambulatory surgical center partnerships and their impact on surgical disease disparities at large.