Association of Medicaid Expansion with In-Hospital Outcomes After Abdominal Aortic Aneurysm Repair

• Published in: The Journal of surgical research 2021-10, Vol.266, p.201-212
• Main Authors: Dakour-Aridi, Hanaa, Malas, Mahmoud B., Farber, Alik, Avgerinos, Efthymios D., Eslami, Mohammad H.
• Format: Article
• Language: English
• Subjects: Abdominal aneurysm repair; Affordable Care Act; Interrupted-time-series analysis; Medicaid expansion; Operative outcomes; Trends
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2021.02.018

Multiple studies have shown improved outcomes and higher utilization of care with the increase of insurance coverage. This study aims to assess whether Medicaid expansion (ME) has changed the utilization and outcomes of abdominal aortic aneurysm (AAA) repair in the United States. Retrospective observational study. Data of patients undergoing AAA repair in the Vascular Quality Initiative (2010-2017). Interrupted time-series (ITS) analysis was utilized to evaluate changes in annual trends of postoperative outcomes after elective AAA repair before and after 2014. We also assessed if these trend changes were significant by comparing the changes in states which adopted ME in 2014 versus nonexpansion states (NME), and conducting a difference-in-difference analysis. Primary outcomes included in-hospital mortality and adverse events (bowel and leg ischemia, cardiac, renal, respiratory, stroke and return to the OR). A total of 19,143 procedures were included (Endovascular: 85.8% and open: 14.2%), of which 40.9% were performed in ME States. Compared to preexpansion trends (P1), there was a 2% annual increase in elective AAA repair in ME states (P1: -1.8% versus P2: +0.2%, P< 0.01) with no significant change in NME (P1: +0.3% versus P2: +0.2%, P = 0.97). Among elective cases, annual trends in the use of EVAR increased by 2% in ME states (95% confidence interval (CI) = -0.1, 4.1, P = 0.06), compared to a 3% decrease in NME States [95%CI = -5.8, -0.6, P = 0.01) (PMEversusNME < 0.01]. There was no association between ME and in-hospital mortality. Nonetheless, it was associated with a decrease in the annual trends of in-hospital complications (ME: -1.4% (-2.1,-0.8) versus NME: +0.2% (-0.2, +0.8), P < 0.01). While no association between ME and increased survival was noted in states which adopted ME, there was a significant increase of elective AAA cases and EVAR utilization and a decrease in in-hospital complications in ME States.