How Safe Are Safety-Net Hospitals? Opportunities to Improve Outcomes for Vulnerable Patients Undergoing Hepatopancreatic
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ORIGINAL ARTICLE
How Safe Are Safety-Net Hospitals? Opportunities to Improve Outcomes for Vulnerable Patients Undergoing Hepatopancreaticobiliary Surgery Ayesha Farooq 1 & Anghela Z. Paredes 1 & Katiuscha Merath 1 & J. Madison Hyer 1 & Rittal Mehta 1 & Kota Sahara 1 & Diamantis I. Tsilimigras 1 & Amika Moro 1 & Lu Wu 1 & Jordan Cloyd 1 & Aslam Ejaz 1 & Timothy M. Pawlik 2,3 Received: 19 July 2019 / Accepted: 30 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Introduction Safety-net hospitals are critical to the US health system as they provide care to vulnerable patients. The effect of hospital safety-net burden on patient outcomes in hepatopancreaticobiliary (HPB) surgery was examined. Methods Discharge data between 2004 and 2014 from the National Inpatient Sample were utilized. Hospitals with a safety-net burden were divided into tertiles: low (LBH) (< 13.6%), medium (MBH) (13.6–33.3%), and high (HBH) (> 33.3%). The association of hospital safety-net burden with complications, in-hospital mortality, never events, and costs were defined. Results Nearly 5% of the analytic cohort (n = 65,032) had surgery at a HBH. Patients treated at HBH were younger (median age, HBH 55 years vs LBH 62 years; p < 0.001), black or Hispanic (HBH 40.5% vs LBH 12.7%; p < 0.001), and of lowest income quartile (HBH 38.4% vs LBH 19.6%; p < 0.001). One-third of patients at HBH experienced a complication compared with only a quarter of patients at LBH (p < 0.001). HBH had higher rates of in-hospital mortality (HBH 6.5% vs. LBH 2.8%; p < 0.001), never events (HBH 5.4% vs. LBH 1.4%; p < 0.001), and a higher cost of surgery (HBH $30,716 vs. LBH $28,054; p < 0.001). Conclusion Perioperative outcomes were worse at HBH, highlighting that efforts are needed to improve their delivery of care. Keywords Safety-net . Disparities . HPB
Introduction Approximately 43 million Americans—more than 13% of the entire United States (US) population—have an income below the poverty threshold.1 Furthermore, in the absence of a universal health insurance program, many impoverished, uninsured, and otherwise vulnerable Americans are left to receive Ayesha Farooq and Anghela Z. Paredes contributed equally to this work. * Timothy M. Pawlik [email protected] 1
Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus OH USA
2
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Columbus OH USA
3
Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite Columbus OH 670 USA
essential healthcare services from safety-net providers who by mandate or mission will provide access to care irrespective of payor source.2 Safety-net hospitals maintain an open-door policy and are committed to serving all patients. As such, a disproportionate number of patients at these hospitals are either Medicaid beneficiaries or have limited or no health coverag
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