Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

The effect of insurance status on outcomes after partial nephrectomy

  • 176 Accesses

  • 8 Citations



Privately insured patients may have favorable health outcomes when compared to those covered by federally funded initiatives. This study explored the effect of insurance status on five short-term outcomes after partial nephrectomy (PN).


Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on PNs performed between 1998 and 2007. We tested the rates of in-hospital mortality, blood transfusions, prolonged length of stay, as well as intraoperative and postoperative complications, stratified according to insurance status. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors.


Overall, 8,513 PNs were identified. Of those, most patients were privately insured (53.5%), followed by Medicare (37.5%), uninsured (4.6%) and Medicaid (4.4%). Medicare and Medicaid patients had higher rates of transfusions (P < 0.001) and overall postoperative complications (P < 0.001). In multivariable analyses, when compared to privately insured patients, Medicaid patients had higher rates of transfusions (OR = 1.91, P < 0.001) and prolonged length of stay (OR = 1.49, P < 0.001). Medicare patients had higher rates of overall postoperative complications (OR = 1.24, P = 0.015) and length of stay beyond the median (OR = 1.4, P < 0.001).


Patients with private insurance undergoing PN have better short-term outcomes, when compared to their publicly insured counterparts.

This is a preview of subscription content, log in to check access.


  1. 1.

    Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279. doi:10.1016/j.juro.2009.07.004

  2. 2.

    Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740. doi:10.1016/S1470-2045(06)70803-8

  3. 3.

    Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P (2000) Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol 163(3):730–736

  4. 4.

    Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, Cindolo L, Han KR, De La Taille A, Tostain J, Artibani W, Abbou CC, Lobel B, Chopin DK, Figlin RA, Mulders PF, Belldegrun AS (2004) Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 171(6 Pt 1):2181–2185 quiz 2435

  5. 5.

    Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, Cindolo L, De la Taille A, Tostain J, Mulders PF, Salomon L, Zigeuner R, Prayer-Galetti T, Chautard D, Valeri A, Lechevallier E, Descotes JL, Lang H, Mejean A, Patard JJ (2007) Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol 25(11):1316–1322. doi:10.1200/JCO.2006.06.1218

  6. 6.

    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137. doi:10.1056/NEJMsa012337

  7. 7.

    Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280(20):1747–1751

  8. 8.

    Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A (2000) Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 283(9):1159–1166

  9. 9.

    Joudi FN, Allareddy V, Kane CJ, Konety BR (2007) Analysis of complications following partial and total nephrectomy for renal cancer in a population based sample. J Urol 177(5):1709–1714. doi:10.1016/j.juro.2007.01.037

  10. 10.

    Corman JM, Penson DF, Hur K, Khuri SF, Daley J, Henderson W, Krieger JN (2000) Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program. BJU Int 86(7):782–789

  11. 11.

    Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, Siegel R, Stewart A, Jemal A (2008) Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin 58(1):9–31. doi:10.3322/CA.2007.0011

  12. 12.

    Drolet S, Maclean AR, Myers RP, Shaheen AAM, Dixon E, Donald Buie W (2010) Morbidity and mortality following colorectal surgery in patients with end-stage renal failure: a population-based study. Dis Colon Rectum 53(20940599):1508–1516

  13. 13.

    Hasan O, Orav EJ, Hicks LS (2010) Insurance status and hospital care for myocardial infarction, stroke, and pneumonia. J Hosp Med 5(20540165):452–459

  14. 14.

    LaPar DJ, Bhamidipati CM, Mery CM, Stukenborg GJ, Jones DR, Schirmer BD, Kron IL, Ailawadi G (2010) Primary payer status affects mortality for major surgical operations. Ann Surg 252(20647910):544–550

  15. 15.

    McClelland S III, Guo H, Okuyemi KS (2011) Population-based analysis of morbidity and mortality following surgery for intractable temporal lobe epilepsy in the United States. Arch Neurol 68(6):725–729. doi:10.1001/archneurol.2011.7

  16. 16.

    Shen JJ, Washington EL (2007) Disparities in outcomes among patients with stroke associated with insurance status. Stroke 38(17234983):1010–1016

  17. 17.

    Charlson M, Pompei P, Ales K, MacKenzie C (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

  18. 18.

    Deyo R, Cherkin D, Ciol M (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

  19. 19.

    United States Census Bureau (2000)

  20. 20.

    Chang CF, Mirvis DM, Waters TM (2008) The effects of race and insurance on potentially avoidable hospitalizations in Tennessee. Med Care Res Rev 65(5):596–616. doi:10.1177/1077558708318283

  21. 21.

    Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, Siegel R, Stewart A, Jemal A (2008) Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin 58(18096863):9–31

  22. 22.

    Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY (2008) Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol 9(18282806):222–231

  23. 23.

    Segal JB, Ness PM, Powe NR (2001) Validating billing data for RBC transfusions: a brief report. Transfusion 41(4):530–533

Download references


Pierre I. Karakiewicz is partially supported by the University of Montreal Health Centre Urology Specialists, Fonds de la Recherche en Sante du Quebec, the University of Montreal Department of Surgery and the University of Montreal Health Centre (CHUM) Foundation.

Author information

Correspondence to Al’a Abdo.

Additional information

Al’a Abdo and Quoc-Dien Trinh contributed equally.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Abdo, A., Trinh, Q., Sun, M. et al. The effect of insurance status on outcomes after partial nephrectomy. Int Urol Nephrol 44, 343–351 (2012).

Download citation


  • Partial nephrectomy
  • Health insurance
  • Cancer outcomes
  • Renal mass
  • Renal neoplasms
  • Insurance status
  • Mortality
  • Postoperative complications