Medicaid and Medicare payer status are associated with worse surgical outcomes in gynecologic oncology

Abstract

Objective: To compare postoperative outcomes by primary payer status for patients with gynecologic malignancies.

Methods: We retrospectively reviewed patients who underwent elective surgery for gynecologic malignancies between 2015 and 2019. Patient outcomes were compared by payer status using logistic regression. Sociodemographic and clinical covariates were selected a priori and included age, American Society of Anesthesiologists physical status classification, body mass index, smoking status, malignancy site, surgery type, race, estimated income, marital status, and medical interpreter requirement.

Results: A total of 1894 patients comprised the study sample. In the multivariate model, compared to patients with private insurance, Medicaid and Medicare patients were more likely to mobilize >24 h after surgery (OR 1.9, p < 0.05 and OR 3.2, p < 0.001, respectively), to require ICU admission (OR 4.0, p < 0.05 and OR 5.0, p < 0.05, respectively), and to have longer lengths of stay (OR 1.8, p < 0.05 and OR 2.2, p < 0.001, respectively). Medicaid patients were also more likely to have higher total hospital costs (OR 1.7, p < 0.05). Payer status was not associated with postoperative pain, postoperative opiate use, or 30-day readmission rates.

Conclusions: Medicaid and Medicare payer status are associated with worse postoperative outcomes in patients with gynecologic malignancies. The poor outcomes of Medicaid patients - a cohort defined by limited income - are noteworthy. The etiology is likely multifactorial, arising from a complex interplay of factors ranging from system issues such as access to care to the unique health status of a population bearing a high burden of disease and socioeconomic adversity.

Keywords: Health disparities; Medicaid; Medicare; Outcomes; Payer status.