The Cost of Poverty: The Relationship Between Insurance Status, Length of Stay, and Discharge Disposition in Trauma Patients

• Published in: The American surgeon 2024-08, Vol.90 (8), p.1990-1993
• Main Authors: Bontrager, Alexandria M., Medvecz, Andrew J., Smith, Candice, Smith, Michael C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Comorbidity; COVID-19; Female; Fractures; Fractures, Bone - economics; Fractures, Bone - therapy; Health care access; Health care policy; Hospital costs; Humans; Indigent care; Insurance; Insurance Coverage - statistics & numerical data; Length of stay; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Medically Uninsured - statistics & numerical data; Middle Aged; Pandemics; Patient Discharge - statistics & numerical data; Patients; Pelvic Bones - injuries; Pneumonia; Poverty; Regression analysis; Rehabilitation; Retrospective Studies; Trauma; Trauma Centers; Uninsured people; Urinary tract diseases; Urinary tract infections; Urogenital system
• ISSN: 0003-1348; 1555-9823; 1555-9823
• DOI: 10.1177/00031348241241656

Introduction Insurance status (IS) is known to be associated with length of stay (LOS). The impact of IS on excess LOS (ELOS), days between medical readiness and discharge date, has not been explored. Methods We conducted a retrospective study of patients with pelvic fractures at a level I trauma center. Outcomes included ELOS (primary), discharge disposition (secondary), and ELOS-associated complications (secondary). Results 185 patients were included. Uninsured patients were the youngest and had the least baseline comorbidities (31.3 years (median), Charlson Comorbidity Index (CCI) .1) while publicly insured patients were the oldest and had the most baseline comorbidities (58.4 years (median), CCI 2.32). Excess LOS and associated complications did not differ among groups. After regression analysis, UIPs had longer LOS than PRPs (2.07 days, 95% CI .28-3.85). UIPs were recommended to go to inpatient rehabilitation 51.6% of the time but were discharged home 93.6% of the time; 81.0% of these changes were attributed to insufficient financial resources. Conclusions Excess LOS and complications associated with ELOS were not associated with IS. Although UIPs were younger and had fewer baseline comorbidities, they had longer LOS after regression analysis. While discharge recommendations differed based on insurance status, UIPs had limited access to rehabilitation due to financial disparities. Despite initial treatment team recommendations, UIPs had to be sent home as their lack of insurance precluded inpatient rehabilitation placement.