Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States

• DOI: 10.1371/journal.pone.0285502
• Publication Date: 2023-05-24T17:28:33Z
• Authors: Sara Sakowitz; Russyan Mark Mabeza; Syed Shahyan Bakh...; Arjun Verma; Shayan Ebrahimian; Amulya Vadlakonda; Sha’shonda Revels; Peyman Benharash
• Keywords: Safety net; Esophagectomy

While safety-net hospitals (SNH) play a critical role in the care of underserved communities, they have been associated with inferior postoperative outcomes. This study evaluated association hospital status clinical and financial outcomes following esophagectomy.All adults (≥18 years) undergoing elective esophagectomy for benign malignant gastroesophageal disease were identified 2010-2019 Nationwide Readmissions Database. Centers highest quartile proportion uninsured/Medicaid patients classified as SNH (others: non-SNH). Regression models developed to evaluate adjusted associations between outcomes, including in-hospital mortality, perioperative complications, resource use. Royston-Parmar flexible parametric used assess time-varying hazard non-elective readmission over 90 days.Of an estimated 51,649 hospitalizations, 9,024 (17.4%) performed at SNH. less frequently suffered from malignancies (73.2 vs 79.6%, p<0.001) compared non-SNH, distribution age comorbidities similar. was independently mortality (AOR 1.24, 95% CI 1.03-1.50), intraoperative complications 1.45, 1.20-1.74) need blood transfusions 1.61, 1.35-1.93). Management also incremental increases LOS (+1.37, 0.64-2.10), costs (+10,400, 6,900-14,000), odds 90-day 1.11, 1.00-1.23).Care higher rehospitalization esophagectomy. Efforts provide sufficient resources may serve reduce overall this procedure.