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Introduction:
Studies have demonstrated that payer status can affect surgical outcomes. Reported outcomes following abdominal aortic aneurysm (AAA) repair, however, are often based on data supplied by Medicare. We hypothesize that privately insured patients receiving open AAA repair have a different risk factor profile than Medicare patients, and that these differences in risk may influence outcomes.
Methods:
De-identified regional data were provided by the Vascular Quality Initiative. All patients undergoing a first-time aortic operation were eligible for inclusion. Analysis was restricted to patients with Medicare or a private payer as their primary insurer. Group differences were tested using Fisher’s exact test and the Wilcoxon rank-sum test as appropriate. Measures of central tendency are presented as medians with interquartile range. Survival was evaluated with Cox proportional hazard models. In a separate analysis, patients were matched using their likelihood of having either payer based upon demographic and pre-procedural clinical variables (propensity matching), and group differences were tested as previously described. Statistical significance was set at α=0.05.
Results:
Of 208 patient records available, Medicare and private insurance accounted for 110 (53%) and 46 (22%) records, respectively. Privately insured patients were younger (63 [9] vs 72 [9] years, p<0.001), were less likely to have coronary disease (14% vs 34%, p=0.014) or hypertension (79% vs 94%, p=0.012), and more likely to present as ASA Class I or II (9% vs 0%, p=0.048). Aneurysm size and other demographic and clinical characteristics were comparable. Unadjusted 30-day mortality was 8.3% in non-Medicare and 9.6% in Medicare patients (p=0.8). Incidence of composite major morbidity in privately insured and Medicare patients was 50% and 48% respectively (p=0.8). Median ICU and post-procedure length of stay were also similar between groups (5 [6] vs 4 [6], p=0.3 and 8 [7] vs 7 [7], p=0.7, respectively). In the propensity matched group, there remained no significant difference between 30-day mortality, composite major morbidity, or post-procedure length of stay.
Conclusions:
Privately insured patients undergoing open AAA are younger with fewer comorbidities than their Medicare-insured counterparts. Despite these baseline differences, there are no clinically or statistically relevant differences in clinical outcomes between these two groups. This finding persists in a propensity-matched cohort. Any conclusions drawn from studies on Medicare patients should therefore be applicable to privately insured patients as well.