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Cancer. 2012 Apr 1;118(7):1803-10. doi: 10.1002/cncr.26475. Epub 2011 Aug 25.

Morbidity and mortality of radical prostatectomy differs by insurance status.

Author information

1
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA. trinh.qd@gmail.com

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.

PMID:
22009603
DOI:
10.1002/cncr.26475
[Indexed for MEDLINE]
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