Abstract
Objective: We sought to determine whether lack of insurance is associated with an increased likelihood of presenting to a hospital with a complicated hernia, and whether insurance status might be associated with clinical outcomes. Context: Delays in elective repair of hernias appear to increase the likelihood of emergency presentation, morbidity, and mortality. Lack of access due to insurance status is a plausible contributor to such delays. Methods: This retrospective study evaluated ambulatory surgical and inpatient hospitalization data from January 1, 2005 through December 31, 2006 in California. Patients who presented for a inguinal, umbilical, or ventral hernia repair or were hospitalized primarily related to the hernia, were at least 5 years old, and had Medicaid (Medi-Cal in California), Medicare, private, or no insurance were included. The main outcome is presentation with a hernia involving bowel obstruction or gangrene, sepsis, or peritonitis. Secondary outcomes evaluated were inpatient mortality, length of hospital stay, and nonoperative management. Results: Out of 147,665 encounters involving hernias, 13,254 (9.0%) involved presentation with a complicated hernia. While only 4.7% of encounters among patients with private insurance were for complicated hernias, 21.1% of those for patients without insurance involved complicated hernias (odds ratio [OR]: 7.02, 95% confidence interval [CI]: 5.05-9.76). Uninsured patients experienced greater mortality (OR: 2.30, 95% CI: 1.01-5.24), lengths of hospital stay (incidence rate ratio: 3.34, 95% CI: 2.61-4.26), and were less likely to undergo operative management (OR: 0.16, 95% CI: 0.11-0.22) than those with private insurance. Conclusions: Lack of insurance is associated with a greater likelihood of presenting with a complicated inguinal, umbilical, or ventral hernia and increased mortality among all patients presenting with hernias at these anatomic sites.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 331-337 |
| Number of pages | 7 |
| Journal | Annals of Surgery |
| Volume | 250 |
| Issue number | 2 |
| DOIs | |
| State | Published - Aug 2009 |
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ASJC Scopus subject areas
- Surgery
Cite this
Lack of insurance is associated with increased risk for hernia complications. / London, Jason A.; Utter, Garth H; Sena, Matthew J.; Chen, Steven L.; Romano, Patrick S.
In: Annals of Surgery, Vol. 250, No. 2, 08.2009, p. 331-337.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Lack of insurance is associated with increased risk for hernia complications
AU - London, Jason A.
AU - Utter, Garth H
AU - Sena, Matthew J.
AU - Chen, Steven L.
AU - Romano, Patrick S
PY - 2009/8
Y1 - 2009/8
N2 - Objective: We sought to determine whether lack of insurance is associated with an increased likelihood of presenting to a hospital with a complicated hernia, and whether insurance status might be associated with clinical outcomes. Context: Delays in elective repair of hernias appear to increase the likelihood of emergency presentation, morbidity, and mortality. Lack of access due to insurance status is a plausible contributor to such delays. Methods: This retrospective study evaluated ambulatory surgical and inpatient hospitalization data from January 1, 2005 through December 31, 2006 in California. Patients who presented for a inguinal, umbilical, or ventral hernia repair or were hospitalized primarily related to the hernia, were at least 5 years old, and had Medicaid (Medi-Cal in California), Medicare, private, or no insurance were included. The main outcome is presentation with a hernia involving bowel obstruction or gangrene, sepsis, or peritonitis. Secondary outcomes evaluated were inpatient mortality, length of hospital stay, and nonoperative management. Results: Out of 147,665 encounters involving hernias, 13,254 (9.0%) involved presentation with a complicated hernia. While only 4.7% of encounters among patients with private insurance were for complicated hernias, 21.1% of those for patients without insurance involved complicated hernias (odds ratio [OR]: 7.02, 95% confidence interval [CI]: 5.05-9.76). Uninsured patients experienced greater mortality (OR: 2.30, 95% CI: 1.01-5.24), lengths of hospital stay (incidence rate ratio: 3.34, 95% CI: 2.61-4.26), and were less likely to undergo operative management (OR: 0.16, 95% CI: 0.11-0.22) than those with private insurance. Conclusions: Lack of insurance is associated with a greater likelihood of presenting with a complicated inguinal, umbilical, or ventral hernia and increased mortality among all patients presenting with hernias at these anatomic sites.
AB - Objective: We sought to determine whether lack of insurance is associated with an increased likelihood of presenting to a hospital with a complicated hernia, and whether insurance status might be associated with clinical outcomes. Context: Delays in elective repair of hernias appear to increase the likelihood of emergency presentation, morbidity, and mortality. Lack of access due to insurance status is a plausible contributor to such delays. Methods: This retrospective study evaluated ambulatory surgical and inpatient hospitalization data from January 1, 2005 through December 31, 2006 in California. Patients who presented for a inguinal, umbilical, or ventral hernia repair or were hospitalized primarily related to the hernia, were at least 5 years old, and had Medicaid (Medi-Cal in California), Medicare, private, or no insurance were included. The main outcome is presentation with a hernia involving bowel obstruction or gangrene, sepsis, or peritonitis. Secondary outcomes evaluated were inpatient mortality, length of hospital stay, and nonoperative management. Results: Out of 147,665 encounters involving hernias, 13,254 (9.0%) involved presentation with a complicated hernia. While only 4.7% of encounters among patients with private insurance were for complicated hernias, 21.1% of those for patients without insurance involved complicated hernias (odds ratio [OR]: 7.02, 95% confidence interval [CI]: 5.05-9.76). Uninsured patients experienced greater mortality (OR: 2.30, 95% CI: 1.01-5.24), lengths of hospital stay (incidence rate ratio: 3.34, 95% CI: 2.61-4.26), and were less likely to undergo operative management (OR: 0.16, 95% CI: 0.11-0.22) than those with private insurance. Conclusions: Lack of insurance is associated with a greater likelihood of presenting with a complicated inguinal, umbilical, or ventral hernia and increased mortality among all patients presenting with hernias at these anatomic sites.
UR - http://www.scopus.com/inward/record.url?scp=68949133123&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68949133123&partnerID=8YFLogxK
U2 - 10.1097/SLA.0b013e3181ae9d27
DO - 10.1097/SLA.0b013e3181ae9d27
M3 - Article
C2 - 19638917
AN - SCOPUS:68949133123
VL - 250
SP - 331
EP - 337
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 2
ER -