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Impact of Insurance Status on Oncologic and Perioperative Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A growing body of research has shown that underinsured patients are at increased risk of worse health outcomes compared with insured patients. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is largely performed at highly specialized cancer centers and may pose challenges for the underinsured. This study investigates surgical outcomes following CRS-HIPEC for insured and underinsured patients with peritoneal carcinomatosis.

Methods

We performed a retrospective cohort study of 125 patients undergoing CRS-HIPEC between 2013 and 2019. Patients were categorized into two groups. The insured group was comprised of patients with private insurance at the time of CRS-HIPEC or who obtained it during the follow-up period. The underinsured group consisted of patients with Medicaid, or self-pay. Perioperative and oncologic outcomes were compared between the two groups.

Results

A total of 102 (82.3%) patients were insured, and 22 (17.7%) patients were underinsured. There were no significant differences in age, medical morbidities, primary tumor characteristics, peritoneal carcinomatosis index, or completion of cytoreduction score between the two groups. The median overall survival (OS) for insured patients was 64.8 months and was 52.9 months for underinsured patients (p = 0.01). Additionally, insured patients had a significantly longer follow-up time. Underinsurance status also was associated with increased hospital and intensive care unit length of stay, and higher rate of Clavien–Dindo classification III–IV complications.

Conclusions

In this retrospective study conducted at a large, urban, specialized cancer center, private insurance status was associated with increased overall survival and longer follow-up period. Furthermore, underinsurance status was associated with increased perioperative morbidity.

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Acknowledgment

The authors acknowledge their funding source: the National Cancer Institute (T32CA106183).

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Authors and Affiliations

  1. Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    David N. Hanna MD, Muhammad O. Ghani MBBS, Christina E. Bailey MD, MSCI, Kamran Idrees MD, MSCI & Deepa Magge MD

  2. Meharry Medical College, Nashville, TN, USA

    Andrew Hermina MD

  3. Vanderbilt University School of Medicine, Nashville, TN, USA

    Alexander Mina BS

Authors
  1. David N. Hanna MD
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  2. Muhammad O. Ghani MBBS
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  3. Andrew Hermina MD
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  4. Alexander Mina BS
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  5. Christina E. Bailey MD, MSCI
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  6. Kamran Idrees MD, MSCI
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  7. Deepa Magge MD
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Correspondence to Deepa Magge MD.

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Hanna, D.N., Ghani, M.O., Hermina, A. et al. Impact of Insurance Status on Oncologic and Perioperative Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 29, 253–259 (2022). https://doi.org/10.1245/s10434-021-10670-2

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  • DOI: https://doi.org/10.1245/s10434-021-10670-2

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