Abstract | May 5, 2021
How does Insurance Status correlate with Trauma Mechanism and Outcomes? A Retrospective Study at a Level 1 Trauma Center
Learning Objectives
- Upon completion of this lecture, learners should be better prepared to discuss how insurance status correlates with injury mechanisms and influence trauma outcomes such as length-of-stay and mortality.
Background:
Insurance status is known to correlate with outcomes for patients hospitalized after acute traumatic injury. However, more research is needed to determine how insurance status is associated with certain mechanisms of injury and subsequently plays a role in influencing treatment outcomes of trauma patients receiving exploratory or reparative surgery in a diverse, metropolitan city.
Goals:
The purpose of this study is to determine how insurance status correlates with certain mechanisms of trauma and influences treatment outcomes of trauma patients admitted for emergent surgery. We hypothesized that patients with Medicaid or no insurance suffer from a higher incidence of penetrating injuries and experience worse treatment outcomes compared to patients of other insurance statuses.
Methods:
We conducted a retrospective cohort study on patients admitted for emergent surgery at a level 1 trauma center in a diverse, metropolitan city. A multivariate logistic regression analysis was performed to investigate how different factors, such as insurance status, affected mortality and hospital length of stay after admission for emergent surgery post-trauma.
Results:
A total of 738 patients met inclusion criteria. The mean age for the study cohort was 35.7 ± 15.6 years. 84% of the study cohort were male and 76% were minorities. The mean age for patients in each insurance cohort are as follows: private insurance (38.5 years), Medicaid (32.7 years), Medicare (69.6 years), other insurance (43.4 years) and no insurance (34.5 years). African Americans were disproportionately more likely to have Medicaid (80.8%) compared to other race cohorts. In terms of trauma modality, Medicaid patients were more likely to suffer penetrating injury compared to other insurance cohorts, as shown in Figure 1. Logistic regression analysis shown in Figure 2 demonstrated that patients with private insurance (OR= 0.139, 95%CI: 0.055-0.353, p<0.05), Medicaid (OR=0.192, 95%CI: 0.105-0.350, p<0.05), Medicare (OR=0.651, 95%CI:0.281-1.511, p=0.318) and other insurance (OR=0.442, 95%CI: 0.224-0.871, p<0.05) experienced lower mortality than uninsured patients. Trauma patients with private insurance (12.5 days, 95%CI: 7.0-21.5), p<0.05) and Medicare (7.0 days, 95%CI: 2.5-12.0, p<0.05) had the longest length of stay in the hospital and ICU, respectively.
Conclusions:
More clinical and research attention should be given to help improve outcomes of uninsured patients. This may include expanding primary intervention programs to help reduce comorbidities and mortality, as well as broadening Medicaid registration for uninsured patients. Furthermore, closer follow-up of uninsured patients upon admittance could reduce incidences of abandoning medical care against advice due to perceived cost or other misunderstandings. More research should also be conducted to explore the underlying mechanisms that lead to differences of clinical outcomes among different insurance cohorts.
