Influence of insurance status on the postoperative outcomes of cytoreductive surgery and HIPEC.

Autor: Kubi B; Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA., Nudotor R; Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA., Fackche N; Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA., Rowe J; Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA., Cloyd JM; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Ahmed A; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Grotz TE; Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, Minnesota, USA., Fournier K; Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Dineen S; Department of Gastrointestinal Oncology and Oncologic Sciences, Moffitt Cancer Center, Morsani College of Medicine, Tampa, Florida, USA., Veerapong J; Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California, USA., Baumgartner JM; Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California, USA., Clarke C; Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Patel SH; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Dhar V; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Lambert L; Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, Massachusetts, USA., Abbott DE; Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, Wisconsin, USA., Pokrzywa C; Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, Wisconsin, USA., Raoof M; Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA., Lee B; Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, California, USA., Zaidi MY; Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA., Maithel SK; Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA., Johnston FM; Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA., Greer JB; Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2023 Mar; Vol. 127 (4), pp. 706-715. Date of Electronic Publication: 2022 Dec 05.
DOI: 10.1002/jso.27147
Abstrakt: Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is increasingly performed for peritoneal surface malignancies but remains associated with significant morbidity. Scant research is available regarding the impact of insurance status on postoperative outcomes.
Methods: Patients undergoing CRS/HIPEC between 2000 and 2017 at 12 participating sites in the US HIPEC Collaborative were identified. Univariate and multivariate analyses were used to compare the baseline characteristics, operative variables, and postoperative outcomes of patients with government, private, or no insurance.
Results: Among 2268 patients, 699 (30.8%) had government insurance, 1453 (64.0%) had private, and 116 (5.1%) were uninsured. Patients with government insurance were older, more likely to be non-white, and comorbid (p < 0.05). Patients with government (OR: 2.25, CI: 1.50-3.36, p < 0.001) and private (OR: 1.69, CI: 1.15-2.49, p = 0.008) insurance had an increased risk of complications on univariate analysis. There was no independent relationship on multivariate analysis. An American Society of Anesthesiologists score of 3 or 4, peritoneal carcinomatosis index score >15, completeness of cytoreduction score >1, and nonhome discharge were factors independently associated with a postoperative complication.
Conclusion: While there were differences in postoperative outcomes between the three insurance groups on univariate analysis, there was no independent association between insurance status and postoperative complications after CRS/HIPEC.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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