Effect of insurance status on patients admitted for acute diverticulitis.

AIM: The study aimed to evaluate the relationship between insurance status and the management and outcome of acute diverticulitis in a nationally representative sample. METHOD: A retrospective cohort analysis of a nationally representative sample of 1 031 665 hospital discharges of patients admitted for acute diverticulitis in the 2006-2009 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project data set. The main outcome measures included state at presentation (complicated/uncomplicated), management (medical/surgical), time to surgical intervention, type of operation and inpatient death. RESULTS: In total, 207 838 discharges were identified (including 37.0% with private insurance, 49.3% in Medicare, 5.6% in Medicaid and 5.8% uninsured) representing 1 031 665 total discharges nationally. Medicare patients were more likely to present with complicated diverticulitis compared with private insurance patients (23.8% vs 15.1%). Time to surgical intervention differed by insurance status. After adjusting for patient, hospital and treatment factors, Medicare patients were less likely than those with private insurance to undergo a procedure (Medicare OR = 0.86, 95% CI: 0.82-0.91), while the uninsured were more likely to undergo drainage (OR = 1.30, 95% CI: 1.16-1.46) or a colostomy only (OR = 1.70, 95% CI: 1.24-2.33). All patients without private insurance were more likely to die in hospital (Medicare OR = 1.29, 95% CI: 1.09-1.52; Medicaid OR = 1.55, 95% CI: 1.22-1.97; uninsured OR = 1.41, 95% CI: 1.07-1.87). CONCLUSION: In a nationally representative sample of patients with acute diverticulitis, patient management and outcome varied significantly by insurance status, despite adjustment for potential confounders. Providers might need to heighten surveillance for complications when treating patients without private insurance to improve outcome.

An assessment of pre-operative microbial screening on the prevention of post-abortion pelvic inflammatory disease.

Five hundred women were examined for lower genital tract infection before vaginal termination of pregnancy. Pre-operatively, Neisseria gonorrhoeae was isolated from nine women (1.8%); five of eight male partners also had gonorrhoea. All the women with gonorrhoea were treated at least 48 h pre-operatively with ampicillin and probenicid; three of them had symptoms of pelvic infection pre-operatively and one had symptoms postoperatively. Of these women, 120 (24%) had a follow-up examination within 47 days of abortion; 15 (3%) required an evacuation of retained products of conception and only 12 (2%) had mild suspected pelvic infection. Screening for Neisseria gonorrhoeae and treatment pre-operatively prevented pelvic infection in a further eight patients.