TY  - JOUR
T1  - PAyer status and treatment paradigm for acute cholecystitis
AU  - Greenstein AJ, Moskowitz A, Gelijns AC, Egorova NN
Y1  - 2012/05/01
N1  - 10.1001/archsurg.2011.1702
JO  - Archives of Surgery
SP  - 453
EP  - 458
VL  - 147
IS  - 5
N2  - Hypothesis 
                  Medicaid recipients who present to the emergency department with acute cholecystitis (AC) would have reduced access to cholecystectomy compared with a similar population of private insurance carriers.Design 
                  The Nationwide Inpatient Sample (NIS) database from 1998 to 2008.Participants 
                  Emergent hospitalizations (843 179) with AC as a primary diagnosis.Interventions 
                  Insurance type was analyzed against cholecystectomy in propensity score–matched cohorts.Main Outcome Measures 
                  Surgical intervention and surgical outcomes.Results 
                  Approximately 200 000 patients were in each matched cohort. The median age of the matched patients was 43.9 years, 76% were women, and the mean Charlson Comorbidity Index was 0.5. While 89% of the private insurance cohort underwent cholecystectomy during their hospitalization, only 83% of the Medicaid population received equivalent care (P < .001). The Medicaid cohort also had reduced rates of laparoscopic surgery (78% vs 69%; P < .001) and an increased conversion rate from laparoscopic to open surgery (3.9% vs 3.0%; P < .001). While disparities in the rates of laparoscopic surgery between the 2 groups sequentially narrowed during the 10-year period, overall disparities in surgical treatment remained constant over time.Conclusions 
                  Medicaid payer status confers inferior access to surgical treatment for AC. While this finding may be due in part to patients' health beliefs and physician preferences, the magnitude of difference suggests that health systems factors may provide a significant contribution toward clinical decision making in this entity.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2011.1702
UR  - http://dx.doi.org/10.1001/archsurg.2011.1702
ER  -