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Treatment of Acute Cholecystitis: Do Medicaid and Non-Medicaid Enrolled Patients Receive the Same Care?

  • 2019 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Nationally, Medicaid enrollees with emergency surgical conditions experience worse outcomes overall when compared with privately insured patients. The goal of this study is to investigate disparities in the treatment of cholecystitis based on insurance type and to identify contributing factors.

Methods

Adults with cholecystitis at a safety-net hospital in Central Massachusetts from 2017–2018 were included. Sociodemographic and clinical characteristics were compared based on Medicaid enrollment status (Medicare excluded). Univariate and multivariate analyses were used to compare the frequency of surgery, time to surgery (TTS), length of stay (LOS), and readmission rates between groups.

Results

The sample (n = 203) included 69 Medicaid enrollees (34%), with a mean age of 44.4 years. Medicaid enrollees were younger (p = 0.0006), had lower levels of formal education (high school diploma attainment, p < 0.0001), were more likely to be unmarried (p < 0.0001), Non-White (p = 0.0012), and require an interpreter (p < 0.0001). Patients in both groups experienced similar rates of laparoscopic cholecystectomy, TTS, and LOS; however, Medicaid enrollees experienced more readmissions within 30 days of discharge (30.4% vs 17.9%, p < 0.001).

Conclusion

Despite anticipated population differences, the treatment of acute cholecystitis was similar between Medicaid and Non-Medicaid enrollees, with the exception of readmission. Further research is needed to identify patient, provider, and/or population factors driving this disparity.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA

    Amanda Fazzalari, Nathaniel Erskine, Demetrius Litwin & Mitchell A. Cahan

  2. The Stanley J. Dudrick Department of Surgery, Saint Mary’s Hospital, 56 Franklin St, Waterbury, CT, 06706, USA

    Amanda Fazzalari & Natalie Pozzi

  3. Division of Data Sciences and Technology, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01605, USA

    David Alfego & Qiming Shi

  4. Department of Finance, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA, 01655, USA

    Gary Tourony

  5. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01605, USA

    Jomol Mathew

Authors
  1. Amanda Fazzalari
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  2. Natalie Pozzi
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  3. David Alfego
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  4. Qiming Shi
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  5. Nathaniel Erskine
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  6. Gary Tourony
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  7. Jomol Mathew
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  8. Demetrius Litwin
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  9. Mitchell A. Cahan
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Contributions

Study conception and design: AF, NP, DL, and MAC

Acquisition of data: AF, DA, and QS

Analysis and interpretation of data: AF, DA, and QS

Drafting of manuscript: AF and DA

Critical revision: AF, NP, DA, QS, NE, GT, JM, DL, and MAC

Corresponding author

Correspondence to Amanda Fazzalari.

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Fazzalari, A., Pozzi, N., Alfego, D. et al. Treatment of Acute Cholecystitis: Do Medicaid and Non-Medicaid Enrolled Patients Receive the Same Care?. J Gastrointest Surg 24, 939–948 (2020). https://doi.org/10.1007/s11605-019-04471-y

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  • DOI: https://doi.org/10.1007/s11605-019-04471-y

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