Clinical and financial outcomes of pulmonary resection for lung cancer in safety-net hospitals

Benharash, Peyman; Verma, Arjun; Mabeza, Russyan Mark; Cho, Nam Yong; Hadaya, Joseph; Toste, Paul A.; Benharash, Peyman

doi:10.1016/j.jtcvs.2022.09.036

Cited by 8 publications

(4 citation statements)

References 32 publications

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“…A growing body of literature has reported adverse surgical outcomes at SNH [ 11 – 15 ]. Building on these studies, we found SNH to be associated with greater in-hospital complications across various domains.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, these patients are among the most vulnerable to variability in healthcare delivery and often have more complex medical profiles [11]. Mounting evidence suggests SNH to be associated with inferior clinical outcomes and higher expenditures across a multitude of surgical procedures [12][13][14][15]. However, reports on such associations in esophagectomy [11] rely on older, more limited cohorts and datasets.…”

Section: Introductionmentioning

confidence: 99%

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Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

Sakowitz,

Mabeza,

Bakhtiyar

et al. 2023

PLoS ONE

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Background While safety-net hospitals (SNH) play a critical role in the care of underserved communities, they have been associated with inferior postoperative outcomes. This study evaluated the association of hospital safety-net status with clinical and financial outcomes following esophagectomy. Methods All adults (≥18 years) undergoing elective esophagectomy for benign and malignant gastroesophageal disease were identified in the 2010–2019 Nationwide Readmissions Database. Centers in the highest quartile for the proportion of uninsured/Medicaid patients were classified as SNH (others: non-SNH). Regression models were developed to evaluate adjusted associations between SNH status and outcomes, including in-hospital mortality, perioperative complications, and resource use. Royston-Parmar flexible parametric models were used to assess time-varying hazard of non-elective readmission over 90 days. Results Of an estimated 51,649 esophagectomy hospitalizations, 9,024 (17.4%) were performed at SNH. While SNH patients less frequently suffered from gastroesophageal malignancies (73.2 vs 79.6%, p<0.001) compared to non-SNH, the distribution of age and comorbidities were similar. SNH was independently associated with mortality (AOR 1.24, 95% CI 1.03–1.50), intraoperative complications (AOR 1.45, 95% CI 1.20–1.74) and need for blood transfusions (AOR 1.61, 95% CI 1.35–1.93). Management at SNH was also associated with incremental increases in LOS (+1.37, 95% CI 0.64–2.10), costs (+10,400, 95% CI 6,900–14,000), and odds of 90-day non-elective readmission (AOR 1.11, 95% CI 1.00–1.23). Conclusions Care at safety-net hospitals was associated with higher odds of in-hospital mortality, perioperative complications, and non-elective rehospitalization following elective esophagectomy. Efforts to provide sufficient resources at SNH may serve to reduce complications and overall costs for this procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

Sakowitz,

Mabeza,

Bakhtiyar

et al. 2023

PLoS ONE

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“…Safety-net burden was incorporated into analysis by calculating the proportion of annual admissions where the primary payer was classified as Medicare or uninsured. Institutions in the highest quartile of safety-net burden were defined as safety-net hospitals (SNH), based on previously published methodology [ 21 ]. Annual institutional volume of SBO admissions was also tabulated using the unique hospital identifiers provided by HCUP.…”

Section: Methodsmentioning

confidence: 99%

The impact of rurality on racial disparities in costs of bowel obstruction treatment

Branche,

Chervu,

Porter

et al. 2024

Surgery Open Science

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“…2 While prior studies have shown that safety-net status is linked to inferior outcomes following anatomic lung resection, coronary artery bypass grafting, and carotid revascularization, outcomes following descending aortic dissection at SNH have not yet been described. [3][4][5] Therefore, the present study aimed to evaluate TBAD management and outcomes at SNH.…”

Section: Introductionmentioning

confidence: 99%

National Trends and Clinical Outcomes of Type B Aortic Dissection Management at Safety-Net Hospitals

Cho¹,

Chervu²,

Verma³

et al. 2023

The American Surgeon™

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Introduction Patients with type B aortic dissection (TBAD) are often underinsured and urgently admitted for open or thoracic endovascular aortic repair (TEVAR). The present study evaluated the association of safety-net status with outcomes among patients with TBAD. Methods The 2012-2019 National Inpatient Sample was queried to identify all adults admitted with type B aortic dissection. Safety-net hospitals (SNHs) were defined as institutions in the top 33% for the annual proportion of uninsured or Medicaid patients. Multivariable regression models were utilized to assess the association of SNH with in-hospital mortality, perioperative complications, length of stay (LOS), hospitalization cost, and non-home discharge. Results Of an estimated 172 595 patients, 61 000 (35.3%) were managed at SNH. Compared to others, patients admitted to SNH were younger, more commonly non-white, and more frequently non-electively admitted. From 2012 to 2019, the annual incidence of type B aortic dissection increased in the overall cohort. Additionally, utilization of TEVAR at non-SNH increased significantly (2012: 6.5% vs 2019: 9.8%), while that of SNH remained similar (2012: 7.4% vs 2019: 7.9%). Patients undergoing open repair had higher mortality at both SNH (12.4 vs 7.8%, P < .001) and non-SNH (13.1 vs 6.1%, P < .001) compared to those receiving TEVAR. After risk adjustment, compared to non-SNH, SNH status was associated with greater odds of mortality, perioperative complications and non-home discharge. Conclusions Our finding suggests that SNH have inferior clinical outcomes for TBAD as well as reduced adoption of endovascular management strategies. Future studies to identify barriers to optimal aortic repair and ameliorate disparities at SNH are warranted.

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Clinical and financial outcomes of pulmonary resection for lung cancer in safety-net hospitals

Cited by 8 publications

References 32 publications

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

The impact of rurality on racial disparities in costs of bowel obstruction treatment

National Trends and Clinical Outcomes of Type B Aortic Dissection Management at Safety-Net Hospitals

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