T. L. Sutton4, E. E. Pracht3, J. M. Guido4, D. J. Ciesla2,4 2Tampa General Hospital,Tampa, FL, USA 3University Of South Florida,College Of Public Health,Tampa, FL, USA 4University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction:
Acute appendicitis is a common condition in acute care surgery, and is often studied as a surrogate for the field. Appendicial perforation is associated with poorer outcomes, longer length of stay (LOS), and greater perioperative complication rates. Prior studies have shown that patients who are uninsured or of low socioeconomic status (SES) have greater likelihoods of presenting with appendicitis complicated by perforation. No comprehensive studies of the relationship between insurance status, treatment, outcomes, and hospital resource utilization in the setting of appendicitis were found in the literature.
Methods:
Patients with acute appendicitis were identified by ICD9 codes using the AHCA Florida Hospital Inpatient Discharge Datasets for 2002 to 2011. Five outcomes were examined: the probability of being admitted with complicated versus uncomplicated appendicitis, the probability of receiving laparoscopic versus open appendectomy, the probability of a perioperative complication, the length of stay in days, and the patient care cost associated with the hospitalization. Data were analyzed using logistic, negative binomial, and least squares multivariate regression, depending on the dependent variable. A p-value less than 0.05 was considered significant. All equations controlled for patient demographics, comorbidities, and year and hospital fixed effects.
Results:
Upon admission, the uninsured had a significantly greater risk of presenting with complicated appendicitis, were less likely to receive a laparoscopic appendectomy, had longer lengths of stay, and greater cost of care. However, the uninsured did not experience significantly different odds of a perioperative surgical complication. These findings were preserved on progressive stratification for complicated or uncomplicated appendicitis and laparoscopic or open appendectomy.
Conclusion:
Patient insurance status is known to affect healthcare utilization. The uninsured may delay seeking medical assistance until later in the course of their disease, causing greater proportions of complicated and costlier to treat appendicitis. Decreasing the number of uninsured via the Affordable Care Act may improve patient outcomes and decrease hospital resource utilization related to acute appendicitis and other acute care surgery conditions.