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dc.contributor.authorDaniel, Vijaya
dc.contributor.authorAyturk, M. Didem
dc.contributor.authorWard, Doyle V.
dc.contributor.authorMcCormick, Beth A.
dc.contributor.authorSantry, Heena P.
dc.date2022-08-11T08:11:02.000
dc.date.accessioned2022-08-23T17:29:31Z
dc.date.available2022-08-23T17:29:31Z
dc.date.issued2019-01-01
dc.date.submitted2019-04-17
dc.identifier.citation<p>Am J Surg. 2019 Jan;217(1):121-125. doi: 10.1016/j.amjsurg.2018.06.025. Epub 2018 Jul 2. <a href="https://doi.org/10.1016/j.amjsurg.2018.06.025">Link to article on publisher's site</a></p>
dc.identifier.issn0002-9610 (Linking)
dc.identifier.doi10.1016/j.amjsurg.2018.06.025
dc.identifier.pmid30017307
dc.identifier.urihttp://hdl.handle.net/20.500.14038/50338
dc.description.abstractBACKGROUND: An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. We evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States. METHODS: Nationwide Inpatient Sample (NIS) was queried to identify patients between 18 and 64 years of age who underwent emergent (open or laparoscopic) repair for UGI perforations secondary to peptic ulcer disease (2010-2014). Primary outcome was in-hospital mortality. Secondary outcomes were major and minor postoperative complications. The main predictor outcome was insurance status (Private, Medicaid, Uninsured). Univariate and multivariable regression analyses were performed. Data were weighted to provide national estimates. RESULTS: 21,005 patients underwent surgical repair for UGI perforations. Patients with private insurance represented the largest payor group (47%). After adjustment of other factors, payor status was not a statistically significant predictor of in-hospital mortality (Medicaid vs. Private: [OR] 1.1; 95% [CI] 0.67-1.81; Uninsured vs. Private: OR 0.9, 95% CI 0.52-1.61). However, payor status remained a statistically significant predictor of major postoperative complications (Medicaid vs. Private [OR] 1.4; 95% CI 1.1, 1.8; Uninsured vs. Private [OR]1.2, 95% CI 0.9, 1.5) and minor postoperative complications (Medicaid vs. Private [OR] 1.4; 95% CI 1.1, 1.9; Uninsured vs. Private [OR]1.2, 95% CI 0.9, 1.6). CONCLUSIONS: Emergency surgery for UGI perforations is associated with high mortality and morbidity across all payor classes; however, Medicaid is a predictor for both major and minor postoperative complications. Preventing perforation through preventative measures will be key to reducing the burden of peptic ulcer disease across all populations.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=30017307&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1016/j.amjsurg.2018.06.025
dc.subjectEmergency general surgery
dc.subjectInsurance
dc.subjectOutcomes
dc.subjectPeptic ulcer disease
dc.subjectUpper gastrointestinal perforations
dc.subjectUMCCTS funding
dc.subjectClinical Epidemiology
dc.subjectEpidemiology
dc.subjectHealth Economics
dc.subjectInsurance
dc.subjectSurgery
dc.subjectSurgical Procedures, Operative
dc.subjectTranslational Medical Research
dc.titleThe influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States
dc.typeJournal Article
dc.source.journaltitleAmerican journal of surgery
dc.source.volume217
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/umccts_pubs/165
dc.identifier.contextkey14282379
html.description.abstract<p>BACKGROUND: An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. We evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States.</p> <p>METHODS: Nationwide Inpatient Sample (NIS) was queried to identify patients between 18 and 64 years of age who underwent emergent (open or laparoscopic) repair for UGI perforations secondary to peptic ulcer disease (2010-2014). Primary outcome was in-hospital mortality. Secondary outcomes were major and minor postoperative complications. The main predictor outcome was insurance status (Private, Medicaid, Uninsured). Univariate and multivariable regression analyses were performed. Data were weighted to provide national estimates.</p> <p>RESULTS: 21,005 patients underwent surgical repair for UGI perforations. Patients with private insurance represented the largest payor group (47%). After adjustment of other factors, payor status was not a statistically significant predictor of in-hospital mortality (Medicaid vs. Private: [OR] 1.1; 95% [CI] 0.67-1.81; Uninsured vs. Private: OR 0.9, 95% CI 0.52-1.61). However, payor status remained a statistically significant predictor of major postoperative complications (Medicaid vs. Private [OR] 1.4; 95% CI 1.1, 1.8; Uninsured vs. Private [OR]1.2, 95% CI 0.9, 1.5) and minor postoperative complications (Medicaid vs. Private [OR] 1.4; 95% CI 1.1, 1.9; Uninsured vs. Private [OR]1.2, 95% CI 0.9, 1.6).</p> <p>CONCLUSIONS: Emergency surgery for UGI perforations is associated with high mortality and morbidity across all payor classes; however, Medicaid is a predictor for both major and minor postoperative complications. Preventing perforation through preventative measures will be key to reducing the burden of peptic ulcer disease across all populations.</p>
dc.identifier.submissionpathumccts_pubs/165
dc.contributor.departmentCenter for Microbiome Research
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.contributor.departmentDepartment of Surgery
dc.source.pages121-125


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