title: The effect of insurance status on outcomes after laparoscopic cholecystectomy.
abstract: BACKGROUND
  Part of the ongoing healthcare debate is the care of uninsured patients. A common theory is that without regular outpatient care, these patients present to the hospital in the late stages of disease and therefore have worse outcomes. The purpose of this study was to evaluate any differences in outcomes after laparoscopic cholecystectomies between insured and uninsured patients.
  
  
  METHODS
  We reviewed all laparoscopic cholecystectomies (LC) done in our institution between 2006 and 2009. Patients were divided into two groups: insured patients (IP) and uninsured patients (UIP). Outcomes, including conversion and complication rates and postoperative length of stay (LOS), were collected and statistically analyzed using χ(2) and ANOVA tests.
  
  
  RESULTS
  There were 1,090 LCs done during the study period: 944 patients (86.6 %) were insured (IP) and 146 (13.4 %) were uninsured (UIP). In the IP group there were 63/944 (6.7 %) conversions and 59/944 (6.3 %) complications, while in the UIP group there were 15/146 (10.3 %) conversions and 12/146 (8.2 %) complications. There was no statistically significant difference in either of these categories. Mean (±SD) LOS was 1.73 ± 4.34 days for the IP group and 2.72 ± 4.35 days for the UIP group (p = 0.010, ANOVA). Uninsured patients were much more likely to have emergency surgery (99.3 % vs. 47.9 %, p < 0.001, χ(2)).
  
  
  CONCLUSIONS
  In our study group, being uninsured did not correlate with having a higher rate of conversion or complications. However, more uninsured patients had their surgery done emergently, and this led to significantly longer lengths of stay. Further research is necessary to study the cost impact of these findings and to see whether insuring these patients can lead to changes in their outcomes.
authors.affiliation: Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Ave, Bronx, NY 10457, USA.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Neureuther
authors.forename: Kamal
authors.initials: K
authors.lastname: Nagpal
authors.forename: Arieh
authors.initials: A
authors.lastname: Greenbaum
authors.forename: John M
authors.initials: JM
authors.lastname: Cosgrove
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Farkas
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000706:statistics & numerical data*; D015897:Comorbidity; D017046:Cost Savings; D048909:Diabetes Complications / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D004630:Emergencies / Q000191:economics; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D019458:Insurance Coverage; D007813:Laparotomy / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009519:New York City; D009765:Obesity / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult