Amini A, et al. - Whether perioperative mortality (death within 30 days of cancer-directed surgery) is predicted by insurance status for the 20 most common surgically treated cancers, was assessed. In this largest reported analysis, death within 30 days of surgery was more likely in patients with Medicaid coverage or without health insurance, and the worst outcomes were observed in those who were uninsured.

Methods

• Using SEER database, data was examined for adults aged 18 to 64 years and the 20 most common surgically resected cancers.
• From 2007 to 2011, a search of the database identified a total of 506,722 patients.

Results

• Insurance status for all patients: non-Medicaid insurance (83%), any Medicaid (10%), uninsured (4%), and unknown (3%).
• Insurance status (P < 0.001), age (P=0.015), race (P < 0.001), marital status (P < 0.001), residence (P=0.002), percent of county below the federal poverty level (P < 0.001), and median county-level income (P < 0.001) were identified as predictors for perioperative mortality in univariate analyses.
• Perioperative mortality was also found to be related to advanced disease (P < 0.001).
• Death within 30 days of surgery was more likely to happen in patients with either Medicaid (Cochran-Mantel-Haenszel odds ratio [CMH OR], 1.21; 95% confidence interval [CI], 1.14-1.29; P<0.001) or uninsured status (CMH OR, 1.56; 95% CI, 1.44-1.70; P<0.001), relative to patients with non-Medicaid insurance, under multivariate analysis.
• Medicaid patients were found to have significantly lower rates of perioperative mortality relative to the uninsured (CMH OR, 0.80; 95% CI, 0.73-0.89, P<0.001).