title: Lack of Insurance is Associated With Increased Risk for Hernia Complications.
abstract: OBJECTIVE
  We sought to determine whether lack of insurance is associated with an increased likelihood of presenting to a hospital with a complicated hernia, and whether insurance status might be associated with clinical outcomes.
  
  
  BACKGROUND
  Delays in elective repair of hernias appear to increase the likelihood of emergency presentation, morbidity, and mortality. Lack of access due to insurance status is a plausible contributor to such delays.
  
  
  METHODS
  This retrospective study evaluated ambulatory surgical and inpatient hospitalization data from January 1, 2005 through December 31, 2006 in California. Patients who presented for a inguinal, umbilical, or ventral hernia repair or were hospitalized primarily related to the hernia, were at least 5 years old, and had Medicaid (Medi-Cal in California), Medicare, private, or no insurance were included. The main outcome is presentation with a hernia involving bowel obstruction or gangrene, sepsis, or peritonitis. Secondary outcomes evaluated were inpatient mortality, length of hospital stay, and nonoperative management.
  
  
  RESULTS
  Out of 147,665 encounters involving hernias, 13,254 (9.0%) involved presentation with a complicated hernia. While only 4.7% of encounters among patients with private insurance were for complicated hernias, 21.1% of those for patients without insurance involved complicated hernias (odds ratio [OR]: 7.02, 95% confidence interval [CI]: 5.05-9.76). Uninsured patients experienced greater mortality (OR: 2.30, 95% CI: 1.01-5.24), lengths of hospital stay (incidence rate ratio: 3.34, 95% CI: 2.61-4.26), and were less likely to undergo operative management (OR: 0.16, 95% CI: 0.11-0.22) than those with private insurance.
  
  
  CONCLUSIONS
  Lack of insurance is associated with a greater likelihood of presenting with a complicated inguinal, umbilical, or ventral hernia and increased mortality among all patients presenting with hernias at these anatomic sites.
authors.affiliation: Division of Trauma and Emergency Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, CA 95817, USA. Jason.london@ucdmc.ucdavis.edu
authors.forename: Jason A
authors.initials: JA
authors.lastname: London
authors.forename: Garth H
authors.initials: GH
authors.lastname: Utter
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Sena
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D046449:Hernia, Abdominal / Q000150:complications* / Q000453:epidemiology* / Q000601:surgery; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult