Effect of insurance status on patients admitted for acute diverticulitis.
OBJECTIVE
The study aimed to evaluate the relationship between insurance status and the management and outcome of acute diverticulitis in a nationally representative sample.


METHODS
A retrospective cohort analysis of a nationally representative sample of 1 031 665 hospital discharges of patients admitted for acute diverticulitis in the 2006-2009 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project data set. The main outcome measures included state at presentation (complicated/uncomplicated), management (medical/surgical), time to surgical intervention, type of operation and inpatient death.


RESULTS
In total, 207 838 discharges were identified (including 37.0% with private insurance, 49.3% in Medicare, 5.6% in Medicaid and 5.8% uninsured) representing 1 031 665 total discharges nationally. Medicare patients were more likely to present with complicated diverticulitis compared with private insurance patients (23.8% vs 15.1%). Time to surgical intervention differed by insurance status. After adjusting for patient, hospital and treatment factors, Medicare patients were less likely than those with private insurance to undergo a procedure (Medicare OR = 0.86, 95% CI: 0.82-0.91), while the uninsured were more likely to undergo drainage (OR = 1.30, 95% CI: 1.16-1.46) or a colostomy only (OR = 1.70, 95% CI: 1.24-2.33). All patients without private insurance were more likely to die in hospital (Medicare OR = 1.29, 95% CI: 1.09-1.52; Medicaid OR = 1.55, 95% CI: 1.22-1.97; uninsured OR = 1.41, 95% CI: 1.07-1.87).


CONCLUSIONS
In a nationally representative sample of patients with acute diverticulitis, patient management and outcome varied significantly by insurance status, despite adjustment for potential confounders. Providers might need to heighten surveillance for complications when treating patients without private insurance to improve outcome.
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. millsa@uphs.upenn.edu
A M
AM
Mills
D N
DN
Holena
M J
MJ
Kallan
B G
BG
Carr
C E
CE
Reinke
R R
RR
Kelz
D018784:Abdominal Abscess / Q000209:etiology / Q000601:surgery; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004239:Diverticulitis, Colonic / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult