The Effect Of Insurance Payer Type On Outcomes And Readmission Rates In Patients Undergoing Breast Reconstruction
Jocellie Marquez, MD, MBA1, Aatman Makadia, BE2, Aaron Zlatopolsky, BA2, Wei Hou, PhD1, Janos Hajagos, PhD1, Sami Khan, MD1.
1Stony Brook University Hospital, Stony Brook, NY, USA, 2Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA.
PURPOSE:This study aims to identify potential differences in outcomes between breast reconstruction covered by government (i.e. Medicare, Medicaid) versus non-government payers (i.e. private, uninsured/self-pay) up to 90-days post-operatively.
METHODS: The Cerner Health Facts database was queried using ICD-9 codes to identify breast reconstructions performed between 2000-2017. Surgical complications and hospital readmissions were estimated using odds ratio (OR) and 95% confidence interval (CI) for each insurance type.
RESULTS: Of 10,153 patients who underwent autologous or tissue expander breast reconstruction, insurance status for the cohort were private (60%), Medicare (11%), Medicaid (7%) and uninsured/self-pay (19%). Medicaid and Medicare patients were more likely to develop infections within 90-days compared to private (OR 2.24 and 2.26 respectively, p=0.0004 and p=<0.0001 respectively) and uninsured/self-pay patients (OR 1.64, and 1.66 respectively, p=0.05 and p=0.02 respectively). Patients with government funded insurance were significantly more likely to have any complication within 90-days compared to non-government insured patients (OR 1.48, p<0.0001). Medicaid and Medicare patients were more likely to be readmitted within 30-days following surgery compared to private insured (OR 2.15 and 1.57,p<0.0001) and self-pay/uninsured patients (OR 1.87 and 1.37 respectively, p=<0.0001 and p=0.005respectively). Medicaid patients had a higher readmission rate in the 31-90 day post-operative period compared to private insured (OR 1.93, p<0.0001) and uninsured/self-pay patients (OR 3.00, p<0.0001).
CONCLUSION: Our study revealed numerous outcomes disparities when controlling for payer type. Patients with government-funded insurance are more likely to experience surgical complications and readmission within 30-days as well as up to 90-days postoperatively.
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