Morbidity and mortality of colorectal carcinoma surgery differs by insurance status

BACKGROUND: Uninsured and underinsured patients are reported to be at an increased risk for impaired access to healthcare, delayed medical treatment, and the receipt of substandard care. These differences in care may result in disparities in surgical outcomes among patients with different types of insurance. In the current study, the authors examined associations between the insurance provider and short-term surgical outcomes after surgery for colorectal carcinoma and evaluated the extent to which two risk factors (comorbid disease and admission type) might explain any observed association. METHODS: The authors conducted a nationally representative retrospective cohort study of 13,415 adults ages 40-64 years who were admitted for surgery for colorectal carcinoma to hospitals that participated in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project National Inpatient Sample, releases 6 and 7, in 1997 and 1998. Multivariate logistic regression models were developed to describe the correlations between insurance status and the risks of a postoperative complication or postoperative death after adjustment for socioeconomic factors, comorbid conditions, and admission type. RESULTS: Uninsured and Medicaid patients were found to have more emergent admissions and more comorbid disease compared with patients with private health insurance. Patients without private health insurance had higher rates of postoperative complications and in-hospital death compared with those patients with private insurance. After adjusting for patient and hospital characteristics, patients with Medicaid were found to be 22% more likely to develop a complication during their hospital admission (odds ratio OR of 1.22; 95% confidence interval 95%CI, 1.06-1.40) and 57% more likely to die postoperatively (OR of 1.57; 95% CI, 1.01-2.42) compared with patients with private insurance. CONCLUSIONS: The current study findings suggest that the uninsured and Medicaid populations are at greater risk of developing postoperative complications and dying than the privately insured population due only in part to preexisting medical comorbidities and emergent admission type.