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Utilization and Outcomes of Inpatient Surgery at Safety-Net Hospitals
- Journal of Health Care for the Poor and Underserved
- Johns Hopkins University Press
- Volume 27, Number 4, November 2016
- pp. 1872-1884
- 10.1353/hpu.2016.0168
- Article
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Funding changes enacted with health care reform may compromise care and outcomes for vulnerable populations undergoing surgery in safety-net hospitals (SNHs). We performed a retrospective cohort study of surgical patients from 2007 through 2011. We examined the distribution of surgical procedures for SNHs (quartile of hospitals with the highest proportion of Medicaid plus self-pay discharges) vs. non-SNHs (lowest quartile). We fit multivariable models to compare in-hospital mortality, prolonged length of stay (LOS), and hospital costs at SNHs vs. non-SNHs. More gynecologic (C-section 10.6% of all procedures at SNH vs. 5.8% non-SNH, p < .001) and fewer orthopedic procedures (joint replacement 4.4% vs. 9.9%, spinal fusion 4.3% vs. 7.1%, p < .001) are performed at SNHs. Across nearly all procedures studied, adjusted inpatient mortality and prolonged LOS were higher at SNHs, while costs remained similar. Further reductions in funding as a consequence of health care reform may threaten access and exacerbate existing health disparities.