Association Between Insurance Type and Outcomes of Reconstructive Head and Neck Cancer Surgery

OBJECTIVES/HYPOTHESIS: Although the benefits of expanding health insurance coverage are clear, there are limited studies comparing the different types of insurance. This study aims to determine the association between insurance type and outcomes in patients with head and neck cancer undergoing reconstructive surgery in the United States. METHODS: Population-based cross-sectional study of the 2012-2014 National Inpatient Sample. We identified 1,314 patients with head and neck cancers undergoing tumor ablative surgery followed by pedicled or free flap reconstruction of oncologic defects. Insurance type was classified as private, Medicare, Medicaid, self-pay, or other. The primary outcome was extended length of stay (LOS), defined as greater than 14 days, which represented the 75th percentile of the study sample. Secondary outcomes included acute medical complications, surgical complications, morbidities, and costs. Analyses were adjusted for gender, geographic location, and various medical comorbidities. RESULTS: In univariate analysis, insurance type was associated with extended LOS (P = .001), medical complications (P = <.001), and mortalities (P = .020). After controlling for other covariates in the multivariate analysis, compared to private insurance, Medicare and Medicaid were both associated with significantly higher odds of extended LOS (adjusted odds ratio OR 95% confidence interval (CI) = 1.73 1.09-2.76 and 2.22 1.38-3.58, respectively). Medicare was associated with significantly higher odds of medical complications, but Medicaid was not (adjusted OR 95% CI = 1.53 1.02-2.31 and 1.64 0.97-2.78, respectively). CONCLUSIONS: Medicaid and Medicare were independently associated with extended LOS after reconstructive head and neck cancer surgery. Medicare was associated with higher rates of medical complications. Efforts to address LOS should target care planning and coordination. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1946-1952, 2022.