title: The effect of insurance status on outcomes after partial nephrectomy.
abstract: BACKGROUND
  Privately insured patients may have favorable health outcomes when compared to those covered by federally funded initiatives. This study explored the effect of insurance status on five short-term outcomes after partial nephrectomy (PN).
  
  
  METHODS
  Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed between 1998 and 2007. We tested the rates of in-hospital mortality, blood transfusions, prolonged length of stay, as well as intraoperative and postoperative complications, stratified according to insurance status. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors.
  
  
  RESULTS
  Overall, 8,513 PNs were identified. Of those, most patients were privately insured (53.5%), followed by Medicare (37.5%), uninsured (4.6%) and Medicaid (4.4%). Medicare and Medicaid patients had higher rates of transfusions (P < 0.001) and overall postoperative complications (P < 0.001). In multivariable analyses, when compared to privately insured patients, Medicaid patients had higher rates of transfusions (OR = 1.91, P < 0.001) and prolonged length of stay (OR = 1.49, P < 0.001). Medicare patients had higher rates of overall postoperative complications (OR = 1.24, P = 0.015) and length of stay beyond the median (OR = 1.4, P < 0.001).
  
  
  CONCLUSIONS
  Patients with private insurance undergoing PN have better short-term outcomes, when compared to their publicly insured counterparts.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal, QC, H2X 3J4, Canada. ala.abdo@umontreal.ca
authors: Al'a
authors: A
authors: Abdo
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Maxine
authors: M
authors: Sun
authors: Jan
authors: J
authors: Schmitges
authors: Marco
authors: M
authors: Bianchi
authors: Jesse
authors: J
authors: Sammon
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Shyam
authors: S
authors: Sukumar
authors: Kevin
authors: K
authors: Zorn
authors: Claudio
authors: C
authors: Jeldres
authors: Paul
authors: P
authors: Perrotte
authors: Craig G
authors: CG
authors: Rogers
authors: James O
authors: JO
authors: Peabody
authors: Mani
authors: M
authors: Menon
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics*; D007680:Kidney Neoplasms / Q000191:economics / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009392:Nephrectomy / Q000191:economics* / Q000379:methods; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology