Methods: Records for CSEC procedures reported to the National Healthcare Safety Network (NHSN) in New York State in 2010-11 were linked to individual patient administrative records in the 2010-11 New York Statewide Planning and Research Cooperative System (SPARCS) based on facility identifier, date of birth, sex, and procedure date. Patients with post-CSEC SSI were identified according to NHSN protocols. Using a retrospective cohort design, we compared the risk of SSI among patients whose primary payer was Medicaid with those who were privately insured. Logistic regression analysis was used to estimate relative risk adjusted for age, race, body mass index, ASA score, duration of surgery, wound classification, emergency procedure status, anesthesia use, hospital size, and labor status. Clustering by facility was accounted for using generalized estimating equations. The private payer arm served as reference.
Results: Eighty-eight percent of eligible NHSN procedures linked 1:1 with a single corresponding SPARCS discharge record; 3208 procedures across 10 acute care hospitals were included. Payer distribution was 57% Medicaid, 32% private insurer, 5% unknown, and 6% other (e.g., self-pay, Medicare). The risk of SSI was 3.5% among Medicaid recipients and 1.2% among those privately insured (P<0.001). The adjusted risk ratio of SSI among Medicaid recipients was 2.1 (95% confidence interval: 1.0-4.2) compared with those privately insured.
Conclusion: The findings suggest an increased risk of SSI following CSEC surgery among patients whose primary payer is Medicaid compared with those who are privately insured. Further study is needed both to confirm the findings of SSI risk by payer and to elucidate potential mechanism(s) of this disparity.
R. Slayton, None
J. Jernigan, None