Abstract
Background and Purpose
Controversy exists whether surgical treatment is influenced by insurance status. American studies suggest higher morbidity and decreased survival in uninsured patients with colorectal cancer (CRC). It remains elusive, however, whether these findings apply to European countries with mandatory, government-driven insurance systems. We aimed to analyze whether operative techniques, quality of surgery, and complication rates differ among patients covered by statutory (SI) versus private (PI) healthcare insurance.
Methods
Based on a prospective national surgical quality database, patients undergoing elective resection for CRC during 2007–2015 were identified. A propensity score match of eligible patients with SI and PI yielded 765 patients per group.
Results
Hierarchical status of the operating surgeon differed substantially (p = 0.001): junior surgeons operated on > 50% of patients with SI, whereas over 80% of patients with PI were operated by senior surgeons. Minimally invasive techniques were used more frequently in patients with PI (p = 0.001) and patients with SI undergoing colonic resection showed an increased conversion rate (OR 2.44). Median duration of surgery (p = 0.001) and blood loss (p = 0.002) were higher in patients with SI; however, length of hospital stay was equal. Neither the rate of positive resection margins nor the number of resected lymph nodes differed among groups. Complications and mortality occurred with similar frequencies for patients undergoing colon (p = 0.140) and rectal (p = 0.335) resection.
Conclusion
The use of minimally invasive techniques was favored in patients with PI; however, the quality of oncological resection was not affected by insurance status and only minor differences in perioperative complications observed.
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Abbreviations
- CRC:
-
Colorectal carcinoma
- SI:
-
Statutory insurance
- PI:
-
Private insurance
- Supp. Info.:
-
Supplementary information
- MIS:
-
Minimally invasive surgery
- IQR:
-
Interquartile range
- NA:
-
Not available
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Acknowledgements
The authors thank Luzi Rageth and the whole team of the AQC database for providing support during analysis of the extracted data.
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Study conception and design: Marcel André Schneider and Matthias Turina; acquisition of data: Marcel André Schneider, Andreas Rickenbacher, Lukas Frick, Daniela Cabalzar-Wondberg, Samuel Käser, and Matthias Turina; analysis and interpretation of data: all authors; drafting of manuscript: Marcel André Schneider, Andreas Rickenbacher, Pierre-Alain Clavien, and Matthias Turina; and critical revision of the manuscript: all authors.
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Schneider, M.A., Rickenbacher, A., Frick, L. et al. Insurance status does not affect short-term outcomes after oncological colorectal surgery in Europe, but influences the use of minimally invasive techniques: a propensity score-matched analysis. Langenbecks Arch Surg 403, 863–872 (2018). https://doi.org/10.1007/s00423-018-1716-8
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DOI: https://doi.org/10.1007/s00423-018-1716-8