How has the Affordable Care Act changed outcomes in Emergency General Surgery?

Introduction Lack of insurance coverage increases complications and mortality from surgical procedures. The 2014 Affordable Care Act (ACA) Open Enrollment (OE) insured more Americans, but it is unknown if this improved outcomes from emergency general surgery (EGS) procedures. This study seeks to determine how ACA OE coverage changes outcomes in EGS. Methods This is a retrospective review using the Nationwide Inpatient Sample (NIS) database from 2012-2014. Patients aged 18-64 undergoing EGS procedures were identified by ICD-9 codes. Medicare patients were excluded. Patient demographics, hospital characteristics and Charlson Comorbidity Index (CCI) were obtained. Outcomes were measured by mortality, complications and calculated costs. Univariate and difference-in-differences (DID) multivariate analyses were performed to determine the effect of the ACA OE on EGS outcomes. Results 304,110 EGS cases were identified. After Medicare patients were excluded, there were 275,425 cases. In 2014 Medicaid (MCD) admissions increased 18.2% from 18,495 to 22,615 (p<.001 and self-pay admissions decreased from to mortality significantly increased for sp patients in did analysis indicated that after risk adjustment the aca oe was associated with a small reduction insured p=".034)," complications wage-index adjusted mean costs there significant increase medicare private insurance teaching hospitals while non-teaching had fewer egs greater uninsured admissions. conclusions created but not reduce mortality. indicating primarily lower-risk patients. cost saw majority of medicaid national registry would improve future study policy on outcomes. type economic level evidence iii. correspondence: jay doucet md division trauma surgical critical care burns acute surgery department university california san diego w. arbor drive. mc ca phone fax authors declare they have no conflicts interest regarding this work. work presented as podium presentation at annual meeting aast clinical congress surgery. september baltimore marriott waterfront md. received external funding. lippincott williams wilkins inc.>

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