Papers by Jasmine C. Tetley
Annals of Surgery Open
Objective: Association of insurance type with colorectal surgical complications, textbook outcome... more Objective: Association of insurance type with colorectal surgical complications, textbook outcomes (TO), and cost in a safety-net hospital (SNH). Background: SNHs have higher surgical complications and costs compared to low-burden hospitals. How does presentation acuity and insurance type influence colorectal surgical outcomes? Methods: Retrospective cohort study using single-site National Surgical Quality Improvement Program (2013–2019) with cost data and risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status and open versus laparoscopic to evaluate 30-day reoperations, any complication, Clavien-Dindo IV (CDIV) complications, TO, and hospitalization variable costs. Results: Cases (Private 252; Medicare 207; Medicaid/Uninsured 619) with patient mean age 55.2 years (SD = 13.4) and 53.1% male. Adjusting for frailty, open abdomen, and urgent/emergent cases, Medicaid/Uninsured patients had higher odds of presenting with PASC (adjusted odds ratio [aOR] = 2.02...
Annals of Surgery Open
Objective: To assess the association of Private, Medicare (MC), and Medicaid/Uninsured (MU) insur... more Objective: To assess the association of Private, Medicare (MC), and Medicaid/Uninsured (MU) insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and costs in a safety-net hospital (SNH) serving diverse socioeconomic status patients. Background: MC’s hospital readmission reduction program (HRRP) disproportionately penalizes SNHs. Methods: This retrospective cohort study used inpatient National Surgical Quality Improvement Program (2013–2019) data merged with cost data. Frailty, expanded operative stress score, case status, and insurance type were used to predict odds of EDOS and readmissions, as well as index hospitalization costs. Results: The cohort had 1477 Private; 1164 MC; and 3488 MU cases with a patient mean age 52.1 years [SD = 14.7] and 46.8% of the cases were performed on male patients. MU [adjusted odds ratio (aOR) = 2.69, 95% confidence interval (CI) = 2.38–3.05, P < 0.001] and MC (aOR = 1.32, 95% CI = 1.11–1.56, P = 0.001) had...
Journal of Gastrointestinal Surgery
Background/Purpose Medicare’s Hospital Readmission Reduction Program disproportionately penalizes... more Background/Purpose Medicare’s Hospital Readmission Reduction Program disproportionately penalizes safety-net hospitals (SNH) caring for vulnerable populations. This study assessed the association of insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and cumulative costs in colorectal surgery patients. Methods Retrospective inpatient cohort study using the National Surgical Quality Improvement Program (2013–2019) with cost data in a SNH. The odds of EDOS and readmissions and cumulative variable (index hospitalization and all 30-day EDOS and readmissions) costs were modeled adjusting for frailty, case status, presence of a stoma, and open versus laparoscopic surgery. Results The cohort had 245 private, 195 Medicare, and 590 Medicaid/uninsured cases, with a mean age 55.0 years (SD = 13.3) and 52.9% of the cases were performed on male patients. Most cases were open surgeries (58.7%). Complication rates were 41.8%, EDOS 12.0%, and readmissions ...
Journal of the American College of Surgeons
BACKGROUND: Surgical outcome/cost analyses typically focus on single outcomes and do not include ... more BACKGROUND: Surgical outcome/cost analyses typically focus on single outcomes and do not include encounters beyond the index hospitalization. STUDY DESIGN: This cohort study used NSQIP (2013-2019) data with electronic health record and cost data risk-adjusted for frailty, preoperative acute serious conditions (PASC), case status, and operative stress assessing cumulative costs of failure to achieve textbook outcomes defined as absence of 30-day Clavien-Dindo level III and IV complications, emergency department visits/observation stays (EDOS), and readmissions across insurance types (private, Medicare, Medicaid, uninsured). Return costs were defined as costs of all 30-day emergency department visits/observation stays and readmissions. RESULTS: Cases were performed on patients (private 1,506; Medicare 1,218; Medicaid 1,420; uninsured 2,178) with a mean age 52.3 years (SD 14.7) and 47.5% male. Medicaid and uninsured patients had higher odds of presenting with preoperative acute serious...
Annals of Surgery Open, 2023
Objective: To assess the association of Private, Medicare (MC), and Medicaid/Uninsured (MU) insur... more Objective: To assess the association of Private, Medicare (MC), and Medicaid/Uninsured (MU) insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and costs in a safety-net hospital (SNH) serving diverse socioeconomic status patients. Background: MC's hospital readmission reduction program (HRRP) disproportionately penalizes SNHs. Methods: This retrospective cohort study used inpatient National Surgical Quality Improvement Program (2013-2019) data merged with cost data. Frailty, expanded operative stress score, case status, and insurance type were used to predict odds of EDOS and readmissions, as well as index hospitalization costs. Results: The cohort had 1477 Private; 1164 MC; and 3488 MU cases with a patient mean age 52.1 years [SD = 14.7] and 46.8% of the cases were performed on male patients. MU [adjusted odds ratio (aOR) = 2.69, 95% confidence interval (CI) = 2.38-3.05, P < 0.001] and MC (aOR = 1.32, 95% CI = 1.11-1.56, P = 0.001) had increased odds of urgent/emergent surgeries and complications versus Private patients. Despite having similar frailty distributions, MU compared to Private patients had higher odds of EDOS (aOR = 1.71, 95% CI = 1.39-2.11, P < 0.001), and readmissions (aOR = 1.35, 95% CI = 1.11-1.65, P = 0.004), after adjusting for frailty, OSS, and case status, whereas MC patients had similar odds of EDOS and readmissions versus Private. Hospitalization variable cost %change was increased for MC (12.5%) and MU (5.9%), but MU was similar to Private after adjusting for urgent/emergent cases. Conclusions: Increased rates and odds of urgent/emergent cases in MU patients drive increased odds of complications and index hospitalization costs versus Private. SNHs care for higher cost populations while receiving lower reimbursements and are further penalized by the unintended consequences of HRRP. Increasing access to care, especially for MU patients, could reduce urgent/ emergent surgeries resulting in fewer complications, EDOS/readmissions, and costs.
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Papers by Jasmine C. Tetley