Acute appendicitis: variation in outcomes by insurance status.

Background: Acute appendicitis (AA) is often studied as a surrogate for acute care surgery. Previous studies have shown differences in outcomes based on insurance status, but associated costs to health care systems are in need of further study. The purpose of the present study was to investigate how treatment, outcomes, and health care resource utilization differ between the uninsured and commercially insured in the setting of AA.

Methods: Patients with AA were identified by International Classification of Diseases, ninth edition, codes using the Agency for Health Care Administration Florida Hospital inpatient discharge data sets for 2002-2011. The outcomes studied were admission with complicated versus uncomplicated appendicitis, receiving laparoscopic versus open appendectomy and experiencing a perioperative complication, length of stay, and overall hospital cost. Data were analyzed using logistic, negative binomial, and least squares multivariate regression. A P value <0.05 was considered significant. All equations controlled for patient demographics, comorbidities, and year and hospital-fixed effects.

Results: The uninsured were more likely to present with complicated appendicitis (odds ratio = 1.31, P < 0.01), less likely to receive laparoscopic appendectomy (odds ratio = 0.70, P < 0.01), had longer length of stay, greater costs but had similar rates of perioperative complications in comparison to the commercially insured.

Conclusions: Insurance status is known to affect health care utilization. The uninsured may delay seeking medical assistance, causing greater incidence of complicated disease and increased costs of treatment. Increasing the number of insured via the Affordable Care Act may improve patient outcomes and decrease costs related to AA. These findings may also apply to other acute care surgery conditions.