Influence of insurance status on the postoperative outcomes of cytoreductive surgery and HIPEC.

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is increasingly performed for peritoneal surface malignancies but remains associated with significant morbidity. Scant research is available regarding the impact of insurance status on postoperative outcomes. METHODS: Patients undergoing CRS/HIPEC between 2000 and 2017 at 12 participating sites in the US HIPEC Collaborative were identified. Univariate and multivariate analyses were used to compare the baseline characteristics, operative variables, and postoperative outcomes of patients with government, private, or no insurance. RESULTS: Among 2268 patients, 699 (30.8%) had government insurance, 1453 (64.0%) had private, and 116 (5.1%) were uninsured. Patients with government insurance were older, more likely to be non-white, and comorbid (p < 0.05). Patients with government (OR: 2.25, CI: 1.50-3.36, p < 0.001) and private (OR: 1.69, CI: 1.15-2.49, p = 0.008) insurance had an increased risk of complications on univariate analysis. There was no independent relationship on multivariate analysis. An American Society of Anesthesiologists score of 3 or 4, peritoneal carcinomatosis index score >15, completeness of cytoreduction score >1, and nonhome discharge were factors independently associated with a postoperative complication. CONCLUSION: While there were differences in postoperative outcomes between the three insurance groups on univariate analysis, there was no independent association between insurance status and postoperative complications after CRS/HIPEC.

Surgical palliative care disparities.

Surgical palliative care is an interdisciplinary treatment modality that aims to decrease suffering and improve the quality of life of seriously ill surgical patients. Although surgical palliative care is increasingly being found to positively impact patient quality of life, disparities in surgical palliative care remain poorly defined. While the field of medical palliative care has demonstrated certain racial/ethnic, socioeconomic, and geographic groups are at higher risks for receiving worse palliative care, there is no analogous consensus in the field of surgical palliative care. This is largely secondary to a paucity of research focus in this field. Given that the aforementioned disparities experienced by minoritized patient populations has led to significant morbidity, it is important to understand and call attention to disparities existing within the field of surgical palliative care as well. To advance the knowledge of current healthcare shortcomings and progress towards equitable surgical palliative care, this paper reviews the current state of surgical palliative care disparities evidence, details gaps in knowledge, and highlights priorities for future surgical palliative care research. The articles identified in this review noted disparate surgical palliative care access and outcomes across various racial/ethnic groups, age ranges, socioeconomic classes, hospital populations, and regions. However, evidence scarcity necessitates more robust research be performed to adequately identify at risk groups and understand the factors supporting disparity development.