Abstract 16140: Primary Payer Status Affects Mortality for Coronary Artery Bypass Grafting Operations
Objectives: Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following coronary artery bypass grafting (CABG) in the United States is related to primary payer status.
Methods: From 2003-2007, 257,764 isolated CABG operations were evaluated using the Nationwide Inpatient Sample (NIS). Patients were stratified by primary payer status: Medicare (n=139,098, age=72.1±0.01), Medicaid (n=12,265, age=56.4±0.04), Private Insurance (n=96,916, age=58.0±0.01), and Uninsured (n=9,485, age=55.1±0.04). Hierarchical multiple regression models were applied to assess the effect of primary payer status on postoperative outcomes.
Results: Unadjusted mortality for Medicare (3.3%), Medicaid (2.4%) and Uninsured (1.9%) patient groups were higher compared to Private Insurance groups (1.1%, p<0.001). Medicaid patients accrued the highest unadjusted length of stay (10.9±0.04 days) and total costs ($113,380±386, p<0.001). Importantly, after controlling for over 60 potential confounders, including patient risk factors, income, hospital features, and hospital operative volume, Medicaid (p<0.001) and Uninsured (p<0.001) payer status was associated with the highest adjusted odds of in-hospital mortality (Table). In addition, Medicaid payer status was associated with the longest adjusted length of stay and highest adjusted total costs (p<0.001).
Conclusions: Medicaid and Uninsured payer status are associated with increased risk adjusted in-hospital mortality for patients undergoing isolated CABG operations. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors. Possible explanations include delays in access to care or disparate differences in health maintenance. Primary payer status should be considered during individual patient risk stratification.
- © 2011 by American Heart Association, Inc.