Morbidity and mortality of radical prostatectomy differs by insurance status.
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.
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA. trinh.qd@gmail.com
Quoc-Dien
QD
Trinh
Jan
J
Schmitges
Maxine
M
Sun
Jesse
J
Sammon
Shahrokh F
SF
Shariat
Kevin
K
Zorn
Shyam
S
Sukumar
Marco
M
Bianchi
Paul
P
Perrotte
Markus
M
Graefen
Craig G
CG
Rogers
James O
JO
Peabody
Mani
M
Menon
Pierre I
PI
Karakiewicz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007902:Length of Stay; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011468:Prostatectomy / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D014481:United States / Q000453:epidemiology