Medicaid patients fare worse after cancer surgery

Low-income patients covered by Medicaid have more complications and higher death rates after colon cancer surgery than patients with private insurance, a U.S. study suggests.

And the difference, researchers found, was not fully explained by generally poorer health, lifestyle factors or higher rates of emergency surgery.

The study, reported in the journal Cancer, reviewed the records of a nationally representative sample of more than 13,400 adults ages 40 to 64 who underwent colon cancer surgery between 1997 and 1998.

Both Medicaid patients and those who lacked insurance had more co-existing health conditions and more emergency hospital admissions than did patients with private insurance. Those on Medicaid were 22 percent more likely to have a post-surgery complication, compared with the privately insured. And they were 57 percent more likely to die in the hospital after surgery.

The risk of complications among uninsured patients was not significantly elevated once the researchers factored in overall health and rates of emergency admission.

This latter finding highlights the fact that a general lack of access to healthcare puts the uninsured at risk for worse outcomes "even in the surgical setting," the study's lead author, Dr. Rachel Rapaport Kelz, told Reuters Health.

According to Kelz and her colleagues at the University of Pennsylvania School of Medicine in Philadelphia, past research has shown that patients on Medicaid and those who lack insurance are more likely to die of colon cancer than patients with private insurance. Less clear has been whether the prognosis is worse even when patients receive surgery for operable colon tumors.

In their study, Kelz and her colleagues found that 24 percent of surgery patients suffered a complication, such as intestinal blockage or infection, while 1 percent died in the hospital after surgery. These risks were higher in Medicaid patients, even when additional factors were weighed - including race, income and lifestyle factors such as drinking.

More research, Kelz said, is needed to examine other potential reasons for the findings. Some factors she pointed to include possible differences in surgeons' expertise or in pre-operative evaluations, which for Medicaid patients and the uninsured may often take place in busy emergency rooms.

SOURCE: Cancer, November 15, 2004.