Morbidity and mortality of radical prostatectomy differs by insurance status

Abstract

BACKGROUND: Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short‐term RP outcomes. METHODS: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003‐2007). We tested the rates of blood transfusions, extended length of stay, intraoperative and postoperative complications, as well as in‐hospital mortality, stratified according to insurance status. Multivariable logistic regression analyses, fitted with general estimation equations for clustering among hospitals, adjusted for confounding factors. RESULTS Overall, 61,167 RPs were identified. Of those, private insurance accounted for the majority of cases (n = 41,312, 67.5%), followed by Medicare (n = 18,759, 30.7%) and Medicaid (n = 1096, 1.8%). Insurance status other than private was associated with higher rates of blood transfusions (P < .001), higher overall postoperative complication rates (P < .001), higher rates of hospital stay above the median (P < .001), as well as higher in‐hospital mortality (P = .01). In multivariable analyses, compared with patients with private insurance, Medicaid patients had higher rates of blood transfusion (odds ratio [OR] = 1.45, P < .001), length of stay beyond the median (OR = 1.61, P < .001) postoperative complications (OR= 1.24, P = .02), and in‐hospital mortality (OR = 4.91, = .01). Similarly, Medicare patients had higher rates of blood transfusions (OR = 1.21, P < .001), overall postoperative complications (OR = 1.17, P×< .001) and length of stay beyond the median (OR = 1.25, P < .001). CONCLUSIONS: Even after adjusting for confounding factors, patients with private insurance have better outcomes than their counterparts with nonprivate insurance. Cancer 2012;. © 2011 American Cancer Society.

American Society of Clinical Oncology Policy Statement on Medicaid Reform

“…[8][9][10][11][12][13][14][15][16][17] For example, data from the National Cancer Data Base revealed that individuals with Medicaid were significantly more likely to be diagnosed with cancer at later (stage III or IV) versus earlier stages (stage I) compared with privately insured patients for 11 of 12 cancer sites examined. The largest negative impacts of Medicaid were seen for cancers that can be diagnosed early through appropriate screening, such as breast cancer (odds ratio, 2.7) and melanoma (odds ratio, 3.3).…”

The diffusion of minimally invasive radical prostatectomy in the United States: a case study of the introduction of new surgical devices

“…32 Finally, our results may only be generalizable to the Medicare population and are not intended to be used to predict outcomes in contemporary cohorts. 33 …”

Disparities in overall and urothelial carcinoma specific mortality associated with healthcare insurance status

“…SES [1,11,12]. The strength of this measure is that particularly for lower SES-associated health insurance plans, an individual review of income is performed on each patient to justify the taxpayer subsidy that often accompanies inclusion in the plan.…”

“…Utilization of the healthcare system has been associated with socioeconomic status (SES) [1]. As such, bladder UC may be a disease where there is an association of socioeconomic status and outcomes.…”

“…There is an increasing body of knowledge that has highlighted the association of poorer outcomes with socioeconomic status and increased mortality from various cancers [2,3]. In bladder UC, several studies have shown some form of survival disparity from bladder UC associated with SES [1,[4][5][6][7][8][9][10]. Most of these studies had the primary endpoint of all-cause mortality, a measure that may be associated with SES regardless of the diagnosis of bladder cancer.…”