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

• Published in: Journal of gastrointestinal surgery Vol. 24; no. 4; pp. 939 - 948
• Main Authors: Fazzalari, Amanda, Pozzi, Natalie, Alfego, David, Shi, Qiming, Erskine, Nathaniel, Tourony, Gary, Mathew, Jomol, Litwin, Demetrius, Cahan, Mitchell A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2020; Springer Nature B.V
• Subjects: 2019 SSAT Quick Shot Presentation; Adult; Aged; Appendicitis; Cardiovascular disease; Cholecystectomy; Cholecystitis, Acute - surgery; Family income; Gallbladder; Gallbladder diseases; Gastroenterology; Humans; Laparoscopy; Length of Stay; Marital status; Medicaid; Medicare; Medicine; Medicine & Public Health; Neighborhoods; Patient Discharge; Patients; Surgery; United States; United States; Disparities; Emergency general surgery; Medicaid; Cholecystitis
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04471-y

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.