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首页> 外文期刊>Cancer: A Journal of the American Cancer Society >Morbidity and mortality of radical prostatectomy differs by insurance status
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Morbidity and mortality of radical prostatectomy differs by insurance status

机译：前列腺癌根治术的发病率和死亡率因保险状况而异

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BACKGROUND: Private insurance status may favorably affect various health outcomes including those associated with radical prostatectomy (RP). We explored the effect of insurance status on 5 short-term RP outcomes. METHODS: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS) we focused on RPs performed within the 5 most contemporary years (2003-2007). We tested the rates of blood transfusions, extended length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to insurance status. Multivariable logistic regression analyses, fitted with general estimation equations for clustering among hospitals, adjusted for confounding factors. RESULTS Overall, 61,167 RPs were identified. Of those, private insurance accounted for the majority of cases (n = 41,312, 67.5%), followed by Medicare (n = 18,759, 30.7%) and Medicaid (n = 1096, 1.8%). Insurance status other than private was associated with higher rates of blood transfusions (P < .001), higher overall postoperative complication rates (P < .001), higher rates of hospital stay above the median (P < .001), as well as higher in-hospital mortality (P = .01). In multivariable analyses, compared with patients with private insurance, Medicaid patients had higher rates of blood transfusion (odds ratio [OR] = 1.45, P < .001), length of stay beyond the median (OR = 1.61, P < .001) postoperative complications (OR= 1.24, P = .02), and in-hospital mortality (OR = 4.91, = .01). Similarly, Medicare patients had higher rates of blood transfusions (OR = 1.21, P < .001), overall postoperative complications (OR = 1.17, Px< .001) and length of stay beyond the median (OR = 1.25, P < .001). CONCLUSIONS: Even after adjusting for confounding factors, patients with private insurance have better outcomes than their counterparts with nonprivate insurance.
机译：背景：私人保险的身份可能会有利地影响各种健康结果，包括那些与前列腺癌根治术（RP）相关的结果。我们探讨了保险状况对5个短期RP结果的影响。方法：在“医疗保健利用项目全国住院患者样本（NIS）”中，我们重点研究了最近5年（2003-2007年）内进行的RP。我们测试了根据保险状况分层的输血率，延长的住院时间，术中和术后并发症以及院内死亡率。多变量logistic回归分析，适用于医院之间聚类的一般估计方程，并根据混杂因素进行了调整。结果总共鉴定出61,167个RP。其中，私人保险占大多数（n = 41,312，67.5％），其次是Medicare（n = 18,759，30.7％）和Medicaid（n = 1096，1.8％）。除私人以外的其他保险身份与更高的输血率（P <.001），更高的总体术后并发症发生率（P <.001），更高的住院时间高于中位数（P <.001）以及住院死亡率较高（P = 0.01）。在多变量分析中，与有私人保险的患者相比，医疗补助患者的输血率更高（优势比[OR] = 1.45，P <.001），住院时间超过中位数（OR = 1.61，P <.001）术后并发症（OR = 1.24，P = .02）和院内死亡率（OR = 4.91，= .01）。同样，Medicare患者的输血率更高（OR = 1.21，P <.001），总体术后并发症（OR = 1.17，Px <.001）和住院时间超过中位数（OR = 1.25，P <.001） ）。结论：即使在调整了混杂因素之后，私人保险的患者也比非私人保险的患者有更好的结局。

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