Abstract
Introduction
Safety-net hospitals provide care to an inherently underprivileged patient population. These hospitals have previously been shown to have inferior surgical outcomes after complex, elective procedures, but little is known about how hospital payer-mix correlates with outcomes after more common, emergent operations.
Methods
The University HealthSystem Consortium database was queried for all emergency general surgery procedures performed from 2009 to 2015. Emergency general surgery was defined as the seven operative procedures recently identified as contributing most to the national burden. Only urgent and emergent admissions were included (n = 653,305). Procedure-specific cohorts were created and hospitals were grouped according to safety-net burden. Multivariate analyses were done to study the effect of safety-net burden on hospital outcomes.
Results
For all seven emergency procedures, patients at hospitals with a high safety-net burden were more likely to be young and black (p < 0.01 each). Patients at high-burden hospitals had similar severity of illness scores to those at other hospitals. Compared with lower burden hospitals, in-hospital mortality rates at high-burden hospitals were similar or lower in five of seven procedures (p = NS or < 0.01, respectively). After adjusting for patient factors, high-burden hospitals had similar or lower odds of readmission in six of seven procedures, hospital length of stay in four of seven procedures, and cost of care in three of seven procedures (p = NS or < 0.01, respectively).
Conclusion
Safety-net hospitals provide emergency general surgery services without compromising patient outcomes or incurring greater healthcare resources. These data may help inform the vital role these institutions play in the healthcare of vulnerable patients in the USA.
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Abbreviations
- ACA:
-
Affordable Care Act
- CI:
-
confidence interval
- DSH:
-
Disproportionate Share Hospital
- EGS:
-
emergency general surgery
- HBH:
-
high burden hospital
- LBH:
-
low burden hospital
- LOS:
-
length of stay
- MBH:
-
medium burden hospital
- NS:
-
not significant
- OR:
-
odds ratio
- ICD-9:
-
International Classification of Diseases, Ninth Revision
- PUD:
-
peptic ulcer disease
- RR:
-
relative risk
- SNH:
-
safety-net hospital
- SOI:
-
severity of illness
- UHC:
-
University HealthSystem Consortium
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Acknowledgements
Vikrom Dhar and Young Kim contributed equally as co-first authors to this manuscript.
Category 1
Conception and design of study:
Vikrom K. Dhar MD, Young Kim MD, Richard S. Hoehn MD, and Shimul A. Shah MD MHCM.
Acquisition of data:
Vikrom K. Dhar MD, Young Kim MD, Koffi Wima MS.
Analysis and/or interpretation of data:
Vikrom K. Dhar MD, Young Kim MD, Koffi Wima MS, Richard S. Hoehn MD, and Shimul A. Shah MD MHCM.
Category 2
Drafting the manuscript:
Vikrom K. Dhar MD, Young Kim MD.
Revising the manuscript critically for important intellectual content:
Vikrom K. Dhar MD, Young Kim MD, Koffi Wima MS, Richard S. Hoehn MD, and Shimul A. Shah MD MHCM.
Category 3
Final approval of the version of the manuscript to be published:
Vikrom K. Dhar MD, Young Kim MD, Koffi Wima MS, Richard S. Hoehn MD, and Shimul A. Shah MD MHCM.
Category 4
Agreement to be accountable for all aspects of the work:
Vikrom K. Dhar MD, Young Kim MD, Koffi Wima MS, Richard S. Hoehn MD, and Shimul A. Shah MD MHCM.
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This study was approved by the Institutional Review Board at the University of Cincinnati.
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University of Cincinnati Department of Surgery.
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The authors declare that they have no conflicts of interest.
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Dhar, V.K., Kim, Y., Wima, K. et al. The Importance of Safety-Net Hospitals in Emergency General Surgery. J Gastrointest Surg 22, 2064–2071 (2018). https://doi.org/10.1007/s11605-018-3885-8
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DOI: https://doi.org/10.1007/s11605-018-3885-8