The Effect of Insurance Status on Surgical Outcomes in Gynecologic Cancer Patients

Abstract

Abstract

Objective:

The aim of this research was to determine the impact of insurance status on 30-day surgical outcomes for the treatment of gynecologic cancer.

Materials and Methods:

A retrospective cohort study of surgically treated gynecologic oncology patients in a large, prospective, cancer-survivorship cohort from April 2010 to August 2016 was performed. Inclusion criteria were: (1) diagnosis of gynecologic cancer; (2) surgical management of the cancer; and (3) documented insurance status. Primary outcomes were any 30-day postoperative complications (Clavien–Dindo score ≥1) and serious 30-day complications (Clavien–Dindo score ≥2). Exposure of interest was insurance status at time of diagnosis, classified as private (PRI), public (PUB), or no insurance/self-pay (NI/SP). Relative risks (RRs) of postoperative complications were estimated using log binomial regression.

Results:

Overall, 458 patients met the inclusion criteria, of which 67% (n = 307) had PRI, 25% (n = 116) had PUB, and 8% (n = 35) had NI/SP. After adjusting for body mass index, cancer stage, and surgical approach, there was no difference in risk of any complications between NI/SP and PUB (RR: 0.68; 95% confidence interval [CI]: 0.43, 1.08) or PRI (RR: 0.89; 95% CI: 0.60, 1.34), or between PUB and PRI (RR: 1.31; 95% CI: 0.93, 1.84). There was also no difference in risk of serious complications between NI/SP and PUB (RR: 1.23; 95% CI: 0.49, 3.04) or PRI (RR: 1.33; 95% CI: 0.57, 3.11), or between PUB and PRI (RR: 1.09; 95% CI 0.66, 1.79).

Conclusions:

Insurance status did not influence the risk of 30-day postoperative complications in this North Carolina cohort of gynecologic cancer patients.