46: PRIMARY PAYER STATUS IS ASSOCIATED WITH TREATMENT ALLOCATION AND CLINICAL OUTCOMES AFTER ADMISSION FOR NON-TRAUMATIC SUBARACHNOID HEMORRHAGE

Abstract

The goal of this study is to examine the association between primary payer status and surgical treatment allocation, outcomes and cost for non-traumatic subarachnoid hemorrhage (SAH) utilizing large national administrative database.

We hypothesize that primary payer status is associated with surgical treatment allocation, outcomes and cost after SAH.

We obtained data for 32732 patients discharged with SAH for the years 2003-2008 from the Nationwide Inpatient Sample hospital discharge database, which is a 20% stratified random sample of all hospital inpatient discharges from approximately 1000 hospitals through the Unites States. We used SURVEY procedures, which properly analyze complex survey data, implemented in SAS (v.9.2, Cary, N.C.).

In multivariate analysis adjusted for patient demographic characteristics, comorbidities, surgery type and hospital characteristics, uninsured patients, Medicaid and Medicare patients had significantly higher odds for dying compared to patients with private insurance. Uninsured patient population incurred the largest 76% increase in the odds of in-hospital mortality (OR 1.76, 95% confidence interval (CI) 1.56- 1.98), followed by the Medicaid (OR 1.19, 95% CI 1.06- 1.34) and Medicare patients (1.14, 95% CI 1.03-1.26). Same analysis revealed significantly increased odds of postoperative complications, length of stay and total costs in the Medicaid group. Medicare patients were almost two times less likely to receive surgical treatment (26%) compared to three other groups (48% Medicaid, 45% private and 44% uninsured patients had surgical treatment). In-hospital mortality rate was highest for hospitals which treated predominantly African American or Hispanics patients or low-income patients.

SAH patients with different types of primary payer status differ significantly in terms of allocation to surgical treatment, postoperative complications, mortality and cost. This is the first study to report difference in access to care and outcomes following treatment for SAH related to primary payer status.