Utilization and Outcomes of Inpatient Surgery at Safety-Net Hospitals.
Funding changes enacted with health care reform may compromise care and outcomes for vulnerable populations undergoing surgery in safety-net hospitals (SNHs). We performed a retrospective cohort study of surgical patients from 2007 through 2011. We examined the distribution of surgical procedures for SNHs (quartile of hospitals with the highest proportion of Medicaid plus self-pay discharges) vs. non-SNHs (lowest quartile). We fit multivariable models to compare in-hospital mortality, prolonged length of stay (LOS), and hospital costs at SNHs vs. non-SNHs. More gynecologic (C-section 10.6% of all procedures at SNH vs. 5.8% non-SNH, p &lt; .001) and fewer orthopedic procedures (joint replacement 4.4% vs. 9.9%, spinal fusion 4.3% vs. 7.1%, p &lt; .001) are performed at SNHs. Across nearly all procedures studied, adjusted inpatient mortality and prolonged LOS were higher at SNHs, while costs remained similar. Further reductions in funding as a consequence of health care reform may threaten access and exacerbate existing health disparities.
Lindsey A
LA
Herrel
Sandra L
SL
Wong
Zaojun
Z
Ye
David C
DC
Miller
D000328:Adult; D005260:Female; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D012189:Retrospective Studies; D064876:Safety-net Providers; D013514:Surgical Procedures, Operative; D014481:United States