title: Payer status and treatment paradigm for acute cholecystitis.
abstract: OBJECTIVE
  Medicaid recipients who present to the emergency department with acute cholecystitis (AC) would have reduced access to cholecystectomy compared with a similar population of private insurance carriers.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) database from 1998 to 2008.
  
  
  METHODS
  Emergent hospitalizations (843 179) with AC as a primary diagnosis.
  
  
  METHODS
  Insurance type was analyzed against cholecystectomy in propensity score-matched cohorts.
  
  
  METHODS
  Surgical intervention and surgical outcomes.
  
  
  RESULTS
  Approximately 200 000 patients were in each matched cohort. The median age of the matched patients was 43.9 years, 76% were women, and the mean Charlson Comorbidity Index was 0.5. While 89% of the private insurance cohort underwent cholecystectomy during their hospitalization, only 83% of the Medicaid population received equivalent care (P.001). The Medicaid cohort also had reduced rates of laparoscopic surgery (78% vs 69%; P.001) and an increased conversion rate from laparoscopic to open surgery (3.9% vs 3.0%; P.001). While disparities in the rates of laparoscopic surgery between the 2 groups sequentially narrowed during the 10-year period, overall disparities in surgical treatment remained constant over time.
  
  
  CONCLUSIONS
  Medicaid payer status confers inferior access to surgical treatment for AC. While this finding may be due in part to patients' health beliefs and physician preferences, the magnitude of difference suggests that health systems factors may provide a significant contribution toward clinical decision making in this entity.
authors.affiliation: Departments of Surgery, The Mount Sinai Medical Center, New York, NY 10029, USA. Alexander.Greenstein@msnyuhealth.org
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Greenstein
authors.forename: Alan
authors.initials: A
authors.lastname: Moskowitz
authors.forename: Annetine C
authors.initials: AC
authors.lastname: Gelijns
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Egorova
mesh_terms: D000328:Adult; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D041881:Cholecystitis, Acute / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D017149:Private Sector; D014481:United States