ArticleJournal of pediatric surgery2013
Primary payer status is significantly associated with postoperative mortality, morbidity, and hospital resource utilization in pediatric surgical patients within the United States.
Article in Journal of pediatric surgery, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Missing data handling in pediatric appendectomy research: current practices and National Surgical Quality Improvement Program (NSQIP) analysis.Surgical endoscopy · 2026Pooled it
- Association of race and socioeconomic status with the use of endovascular repair to treat thoracic aortic diseases.Journal of vascular surgery · 2013Trial
- Social Drivers of Health in Pediatric Perioperative Care.Anesthesiology · 2026Review
- The economic burden of ventriculoperitoneal shunt insertion and its complications: findings from a cohort in the Philippines.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024Article
- Influence of Health Insurance Coverage on the Survival Rate for Primary Total Knee Arthroplasty: Minimum 5-Year Follow-Up Analysis.Healthcare (Basel, Switzerland) · 2024Article
- Disparities in insurance status negatively affect patients with infantile hypertrophic pyloric stenosis.Pediatric surgery international · 2024Article
- Effect of insurance status on perioperative outcomes after robotic pancreaticoduodenectomy: a propensity-score matched analysis.Journal of robotic surgery · 2024Article
- Demographic, Socioeconomic, and Clinical Factors Associated with Severe Vision Loss in Patients with Neovascular Glaucoma.Clinical ophthalmology (Auckland, N.Z.) · 2024Article
- Prescribed Opioid Dosages, Payer Type, and Self-Reported Outcomes After Surgical Procedures in Michigan, 2018-2020.JAMA network open · 2023Article
- Postprocedural Complications Hospitalization Pattern Among Paediatric Patients at National Health Service Trusts: An Ecological Study in England and Wales.Journal of multidisciplinary healthcare · 2023Article
- Postoperative complications after gastrointestinal pediatric surgical procedures: outcomes and socio-demographic risk factors.BMC pediatrics · 2022Article
- Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures.Hand (New York, N.Y.) · 2022Article
- Use of the MMPI-2 personality profile in predicting 30-day ED-visits and readmissions following primary bariatric surgery.Surgical endoscopy · 2021Article
- Insurance Payer Type and Patient Income Are Associated with Outcomes after Total Shoulder Arthroplasty.The Journal of rheumatology · 2020Article
- Medicaid insurance status predicts postoperative mortality after total knee arthroplasty in state inpatient databases.Journal of comparative effectiveness research · 2019Article
- Payer and race/ethnicity influence length and cost of childhood cancer hospitalizations.Pediatric blood & cancer · 2019Article
- Health Care Access Barriers Bring Children to Emergency Rooms More Frequently: A Representative Survey.Population health management · 2019Article
- Payer type does not impact patient-reported outcomes after primary total knee arthroplasty.Arthroplasty today · 2019Article
- The Disparities of Coronary Artery Bypass Grafting Surgery Outcomes by Insurance Status: A Retrospective Cohort Study, 2007-2014.World journal of surgery · 2018Article
- Medicaid is associated with increased readmission and resource utilization after primary total knee arthroplasty: a propensity score-matched analysis.Arthroplasty today · 2018Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
purposeCurrent healthcare reform efforts have highlighted the potential impact of insurance status on patient outcomes. The influence of primary payer status (PPS) within the pediatric surgical patient population remains unknown. The purpose of this study was to examine risk-adjusted associations between PPS and postoperative mortality, morbidity, and resource utilization in pediatric surgical patients within the United States.
methodsA weighted total of 153,333 pediatric surgical patients were evaluated using the national Kids' Inpatient Database (2003 and 2006): appendectomy, intussusception, decortication, pyloromyotomy, congenital diaphragmatic hernia repair, and colonic resection for Hirschsprung's disease. Patients were stratified according to PPS: Medicare (n=180), Medicaid (n=51,862), uninsured (n=12,539), and private insurance (n=88,753). Multivariable hierarchical regression modeling was utilized to evaluate risk-adjusted associations between PPS and outcomes.
resultsOverall median patient age was 12 years, operations were primarily non-elective (92.4%), and appendectomies accounted for the highest proportion of cases (81.3%). After adjustment for patient, hospital, and operation-related factors, PPS was independently associated with in-hospital death (p<0.0001) and postoperative complications (p<0.02), with increased risk for Medicaid and uninsured populations. Moreover, Medicaid PPS was also associated with greater adjusted lengths of stay and total hospital charges (p<0.0001). Importantly, these results were dependent on operation type.
conclusionsPrimary payer status is associated with risk-adjusted postoperative mortality, morbidity, and resource utilization among pediatric surgical patients. Uninsured patients are at increased risk for postoperative mortality while Medicaid patients accrue greater morbidity, hospital lengths of stay, and total charges. These results highlight a complex interaction between socioeconomic and patient-related factors, and primary payer status should be considered in the preoperative risk stratification of pediatric patients.
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