title: Emergency general surgery outcomes at safety net hospitals.
abstract: BACKGROUND
  The United States hospital safety net is defined by the Agency for Healthcare Research and Quality as the top decile of hospitals, which see the greatest proportion of uninsured patients. These hospitals provide important access to health care for uninsured patients but are commonly believed to have worse outcomes. The aim of this study was to compare the outcomes of emergency general surgery procedures performed at safety net and nonsafety net hospitals.
  
  
  METHODS
  The Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2008-2010 was used to create a cohort of inpatients who underwent emergency appendectomy, cholecystectomy, or herniorrhaphy. Outcomes measured included length of stay, charge, cost, death in hospital, complications, and failure to rescue (FTR). Univariate and logistic regression analysis was performed to associate variables with outcomes.
  
  
  RESULTS
  A total of 187,913 emergency general surgery cases were identified, 11.5% of which were performed at safety net hospitals. The safety net cohort had increased length of stay but lower mean charge and cost. Age, comorbidity score, black race, male gender, and Medicaid and Medicare insurance were associated with mortality, complication, and FTR. Lower socioeconomic status was associated with mortality and complication. Safety net status was positively associated with complication but not mortality or FTR.
  
  
  CONCLUSIONS
  Safety net hospitals had higher complication rates but no difference in FTR or mortality. This may mean that the hospitals are able to effectively recognize and treat patient complications and do so without increased cost.
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors: Charles Patrick
authors: CP
authors: Shahan
authors: Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Teresa
authors: T
authors: Bell
authors: Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors: Elena
authors: E
authors: Paulus
authors: Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: bzarzaur@iupui.edu.
authors: Ben L
authors: BL
authors: Zarzaur
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000191:economics; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000191:economics / Q000401:mortality*; D016896:Treatment Outcome
keywords: Emergency general surgery; Health care policy; Safety net