ImportanceAccess-sensitive surgical conditions, such as abdominal aortic aneurysm, ventral hernia, and colon cancer, are ideally treated with elective surgery, but when left untreated have a natural history requiring an unplanned operation. Patients’ health insurance status may be a barrier to receiving timely elective care, which may be associated with higher rates of unplanned surgery and worse outcomes.ObjectiveTo evaluate the association between patients’ insurance status and rates of unplanned surgery for these 3 access-sensitive surgical conditions and postoperative outcomes.Design, Setting, and ParticipantsThis cross-sectional cohort study examined a geographically broad patient sample from the Healthcare Cost and Utilization Project State Inpatient Databases, including data from 8 states (Arizona, Colorado, Florida, Kentucky, Maryland, North Carolina, Washington, and Wisconsin). Participants were younger than 65 years who underwent abdominal aortic aneurysm repair, ventral hernia repair, or colectomy for colon cancer between 2016 and 2020. Patients were stratified into groups by insurance status. Data were analyzed from June 1 to July 1, 2023.ExposureHealth insurance status (private insurance, Medicaid, or no insurance).Main Outcomes and MeasuresThe primary outcome was the rate of unplanned surgery for these 3 access-sensitive conditions. Secondary outcomes were rates of postoperative outcomes including inpatient mortality, any hospital complications, serious complications (a complication with a hospital length of stay longer than the 75th percentile for that procedure), and hospital length of stay.ResultsThe study included 146 609 patients (mean [SD] age, 50.9 [10.3] years; 73 871 females [50.4%]). A total of 89 018 patients (60.7%) underwent elective surgery while 57 591 (39.3%) underwent unplanned surgery. Unplanned surgery rates varied significantly across insurance types (33.14% for patients with private insurance, 51.46% for those with Medicaid, and 72.60% for those without insurance; P < .001). Compared with patients with private insurance, patients without insurance had higher rates of inpatient mortality (1.29% [95% CI, 1.04%-1.54%] vs 0.61% [0.57%-0.66%]; P < .001), higher rates of any complications (19.19% [95% CI, 18.33%-20.05%] vs 12.27% [95% CI, 12.07%-12.47%]; P < .001), and longer hospital stays (7.27 [95% CI, 7.09-7.44] days vs 5.56 [95% CI, 5.53-5.60] days, P < .001).Conclusions and RelevanceFindings of this cohort study suggest that uninsured patients more often undergo unplanned surgery for conditions that can be treated electively, with worse outcomes and longer hospital stays compared with their counterparts with private health insurance. As efforts are made to improve insurance coverage, tracking elective vs unplanned surgery rates for access-sensitive surgical conditions may be a useful measure to assess progress.

中文翻译：

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健康保险状况和对手术敏感的手术条件的计划外手术

重要性 腹主动脉瘤、腹疝和结肠癌等对手术敏感的疾病，最好通过择期手术进行治疗，但如果不及时治疗，就会有需要进行计划外手术的自然史。患设计、设置和参与者这项横断面队列研究检查了来自医疗保健成本和利用项目州住院患者数据库的地理广泛的患者样本，包括来自 8 个州（亚利桑那州、科罗拉多州、佛罗里达州、肯塔基州、马里兰州、北卡罗来纳州）的数据。卡罗来纳州、华盛顿州和威斯康星州）。参与者年龄小于 65 岁，在 2016 年至 2020 年间接受过腹主动脉瘤修复术、腹疝修复术或结肠癌结肠切除术。患者根据保险状况进行分组。数据分析时间为 2023 年 6 月 1 日至 7 月 1 日。暴露健康保险状况（私人保险、医疗补助或无保险）。主要结果和措施主要结果是这 3 种访问敏感疾病的计划外手术率。次要结局是术后结局率，包括住院死亡率、任何住院并发症、严重并发症（住院时间超过该手术第 75 个百分位数的并发症）以及住院时间。 结果该研究包括 146 609 名患者（平均[SD] 年龄，50.9 [10.3] 岁；73 871 名女性 [50.4%]）。共有 89 018 名患者（60.7%）接受了择期手术，而 57 591 名患者（39.3%）接受了非计划手术。不同保险类型的计划外手术率差异很大（有私人保险的患者为 33.14%，有医疗补助的患者为 51.46%，无保险的患者为 72.60%；磷< .001）。与有私人保险的患者相比，无保险的患者住院死亡率较高（1.29% [95% CI, 1.04%-1.54%] vs 0.61% [0.57%-0.66%]；磷< .001），任何并发症发生率较高（19.19% [95% CI, 18.33%-20.05%] vs 12.27% [95% CI, 12.07%-12.47%]；磷< .001），以及更长的住院时间（7.27 [95% CI, 7.09-7.44] 天 vs 5.56 [95% CI, 5.53-5.60] 天，磷< .001).结论和相关性这项队列研究的结果表明，与拥有私人健康保险的患者相比，未投保的患者更经常因可以选择性治疗的疾病而接受计划外手术，结果更差，住院时间更长。随着努力提高保险覆盖范围，跟踪对手术敏感的手术条件的选择性手术与计划外手术的比率可能是评估进展的有用措施。