Q.D. Trinh and J. Schmitges contributed equally to this article.
Morbidity and mortality of radical prostatectomy differs by insurance status
Article first published online: 25 AUG 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 7, pages 1803–1810, 1 April 2012
How to Cite
Trinh, Q.-D., Schmitges, J., Sun, M., Sammon, J., Shariat, S. F., Zorn, K., Sukumar, S., Bianchi, M., Perrotte, P., Graefen, M., Rogers, C. G., Peabody, J. O., Menon, M. and Karakiewicz, P. I. (2012), Morbidity and mortality of radical prostatectomy differs by insurance status. Cancer, 118: 1803–1810. doi: 10.1002/cncr.26475
- Issue published online: 19 MAR 2012
- Article first published online: 25 AUG 2011
- Manuscript Accepted: 11 JUL 2011
- Manuscript Revised: 7 JUN 2011
- Manuscript Received: 29 MAR 2011
- prostatic neoplasms;
- complication, insurance, Medicare, Medicaid
Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short-term RP outcomes.
Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003-2007). We tested the rates of blood transfusions, extended length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to insurance status. Multivariable logistic regression analyses, fitted with general estimation equations for clustering among hospitals, adjusted for confounding factors.
Overall, 61,167 RPs were identified. Of those, private insurance accounted for the majority of cases (n = 41,312, 67.5%), followed by Medicare (n = 18,759, 30.7%) and Medicaid (n = 1096, 1.8%). Insurance status other than private was associated with higher rates of blood transfusions (P < .001), higher overall postoperative complication rates (P < .001), higher rates of hospital stay above the median (P < .001), as well as higher in-hospital mortality (P = .01). In multivariable analyses, compared with patients with private insurance, Medicaid patients had higher rates of blood transfusion (odds ratio [OR] = 1.45, P < .001), length of stay beyond the median (OR = 1.61, P < .001) postoperative complications (OR= 1.24, P = .02), and in-hospital mortality (OR = 4.91, = .01). Similarly, Medicare patients had higher rates of blood transfusions (OR = 1.21, P < .001), overall postoperative complications (OR = 1.17, P×< .001) and length of stay beyond the median (OR = 1.25, P < .001).
Even after adjusting for confounding factors, patients with private insurance have better outcomes than their counterparts with nonprivate insurance. Cancer 2012;. © 2011 American Cancer Society.