By Andrew M. Seaman
NEW YORK (Reuters Health) - The type of insurance people have is tied to their risk of needing emergency aorta surgery, according to a new study. Insurance, or lack thereof, is also linked to how well those people fare after surgery.
Compared to people with private insurance, people without insurance were more likely to need emergency surgery on their aorta, the largest artery that supplies blood to every part of the body. They were also more likely to die or have complications after surgery.
"It would appear that if you don't have insurance - and assuming you're not getting preventive healthcare . . . then you are probably at a higher risk of having an aortic catastrophe and, if you have one, you're more likely to die or have a complication," Dr. G. Chad Hughes told Reuters Health.
Hughes is the study's senior author from Duke University Medical Center in Durham, North Carolina.
Conditions affecting the aorta, such as a bulge or break in the artery's walls, are responsible for 30,000 to 60,000 deaths every year in the U.S., he and his colleagues write in the journal Circulation: Cardiovascular Quality and Outcomes.
Less than 5 percent of patients die during a scheduled surgery to repair a diseased part of the aorta, they write. The death rate increases to about 50 percent when the surgery is done during an emergency, such as when the aorta ruptures or breaks.
About 40 percent of aortic surgeries are performed as emergencies. Catching some of those cases early and repairing the diseased aorta during a scheduled surgery may increase the number of people who survive.
It's known that people with insurance tend to get better care to prevent conditions that contribute to the risk of aortic disease, like high blood pressure and high cholesterol. The researchers suggest insured people may also be more likely to have scheduled aortic surgery - instead of waiting until the aorta ruptures.
For the new study, Hughes and his colleagues used a national database that tracks heart-related procedures at 1,091 healthcare centers across the U.S.
They compared the type of aorta surgeries and outcomes experienced by 51,282 people with private insurance, public insurance or no insurance. The study specifically looked at surgeries conducted between 2007 and 2011 that fixed the part of the aorta located in the chest.
Among people younger than 65 years old, about 36 percent of those with private insurance needed emergency or urgent surgery, compared to about 73 percent of people with no insurance. The others had scheduled surgery.
People with Medicaid, the state and federal health insurance for the poor, were also more likely to need urgent or emergency surgery than those with private insurance.
What's more, uninsured patients and those with Medicaid and Medicare, the federal health insurance for the elderly and disabled, were more likely than people with private insurance to die or have complications. Those complications included developing an infection, having a stroke or needing another operation.
Patients age 65 and older were also more likely to undergo emergency or urgent surgery if they lacked insurance, but there was no difference in their complication rates based on insurance type. Any possible effect of insurance may have been dampened by older patients already having a tendency to have poorer outcomes after surgery.
"There's a preponderance of evidence that shows findings similar to this that uninsured patients tend to present with more advanced disease," Dr. Andrew Loehrer said. "I think this paper adds to that literature."
Loehrer, who is from Massachusetts General Hospital in Boston, was not involved with the new study but has researched surgical access and outcomes among low-income populations.
"It's been challenging to dissect exactly why that is," he said, because people without insurance or with Medicaid may already be in poorer health and have other traits that could affect how well they fare after surgery.
Hughes said researchers will have to examine how increased insurance access through the Affordable Care Act, commonly known as Obamacare, may influence these results over the coming years.
"I figured we'd see exactly what we saw," he said. "I think the question is, if you get these people coverage, will that make a difference? The answer right now is, we don't know."
SOURCE: http://bit.ly/PcuFs9 Circulation: Cardiovascular Quality and Outcomes, online April 8, 2014.