Umbrellas Don't Make It Rain - Worse Outcomes In Dual-Eligible Beneficiaries Following Emergency Laparotomy
*Krissia M Rivera Perla1, *Joao Filipe G Monteiro2, *Oliver Tang1, *Ashwin Veeramani1, *Youry Pierre-Louis1, *Olabade Omole1, *Chibueze A Nwaiwu1, *Robert Weil3, Daithi S Heffernan4, *Carla C Moreira4, Nishit Shah1, SURGE Lab Collaborators
1Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI;2Department of Medicine, Rhode Island Hospital, Providence, RI;3Department of Neurosurgery, Rhode Island Hospital, Providence, RI;4Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital; Department of Surgery, Veterans Administration Medical Center, Providence, RI
Objective: Dual-Eligible beneficiaries are patients who receive both Medicare and Medicaid. They represent a vulnerable population with high resource utilization and are more likely to experience negative social determinants of health. The impact of socioeconomic status following emergency laparotomy (EL), a procedure with known higher acuity of care, has not been well-examined. This study sought to better characterize perioperative outcomes after EL in Dual-Eligibles compared to non-Dual-Eligible patients.
Design: National Inpatient Sample (NIS) retrospectively analyzed over a 10-year period. Analysis done using Chi-Square and T-Test. Multivariable logistic regressions used to control for gender, age, and race.
Setting: N/A
Patients: Adults undergoing EL; including small and large bowel resection, perforated ulcer.
Interventions: None
Main Outcome Measures: Complications, including infection and inpatient mortality, length of stay (LOS) and discharge disposition.
Results: 238,327 patients met inclusion criteria. Dual-Eligibles comprised 10.1% of patients and were on average younger (68.1 years) than Medicare (73.7) but older than Medicaid (44.4), Private (50.3), and Self-Pay (42.3), p<0.0001. After adjusting for confounders, Dual-Eligibles had significantly longer mean LOS (15.9 days) compared to Medicare (14.3), Medicaid (13.9), Private (10.7) and Self-Pay (9.9), p<0.0001. Additionally, Dual-Eligibles had significantly higher inpatient mortality and were less often discharged home compared to Medicare, Medicaid, Private, and Self-Pay (Table).
Conclusions: Dual-Eligibles undergoing EL had longer LOS than all other patient groups, higher inpatient mortality and were less likely to be discharged home. These worse outcomes in Dual-Eligibles signal a need for targeted perioperative interventions of modifiable risk factors in order to lessen these disparities.
| Dual-Eligibles | Medicare | Medicaid | Private | Self-Pay | |
| Inpatient Mortality | 14.09% | 13.22%; 1.22 (1.17 - 1.28)**** | 6.57%; 1.24 (1.14 - 1.34)**** | 4.06%; 1.87 (1.75 - 1.99)**** | 5.07%; 1.63 (1.48 - 1.79)**** |
| Discharge to Home | 45.03% | 52.19%; 0.59 (0.57 - 0.61)**** | 79.02%; 0.47 (0.45 - 0.50)**** | 87.23%; 0.27 (0.26 - 0.28)**** | 89.11%; 0.22 (0.20 - 0.23)**** |
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