Impact of insurance type in postoperative emergency department utilization and clinical outcomes following ventral hernia repair (VHR)

Background: Access to care and barriers to achieving health equity remain persistent and prevailing issues in the USA, particularly for low socioeconomic (L-SES) populations. Previous studies have shown that public insurance (a surrogate marker for L-SES) is an independent predictor of emergent hernia repair. However, the impact of insurance type on postoperative healthcare utilization, including emergency department (ED) care, following ventral hernia repair (VHR) remains unknown.

Methods: The 2013-2020 Abdominal Core Health Quality Collaborative (ACHQC) database was used to identify patients aged 18-64 undergoing ventral hernia repair (VHR) who had private or Medicaid insurance. Patients with no health insurance were also included. Using insurance type, the cohort was divided into three groups: private, public (Medicaid), and uninsured (self-pay). Multivariate logistic regression analyses were used to assess the impact of insurance type on emergency department (ED) utilization, postoperative complications, and readmission.

Results: A total of 17,036 patients undergoing VHR were included in the study, out of which 13,980 (85.8%) had private insurance, 2,451 (8.4%) had public, and 605 (5.8%) were uninsured. Following adjustment for demographics (age, gender, race), comorbidities (hypertension, diabetes, smoking), and clinical characteristics (emergent procedure, ASA class, surgical approach), public insurance was associated with 1.7 times greater odds of returning to the emergency department (ED) within 30 days of surgery compared to private insurance (95% CI 1.4, 2.0; p = 0.01). Public insurance or being uninsured was also associated with increased odds of experiencing any postoperative complications compared to those who were privately insured (public: OR 1.3, p < 0.01; self-pay: OR 1.67, p < 0.01).

Conclusion: Our study demonstrates that public and self-pay insurance are associated with increased emergency department (ED) utilization and worse postoperative outcomes compared to those with private insurance. In an effort to promote health equity, healthcare providers need to assess how parameters beyond physical presentation may impact a patient's health.