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Annals of Surgery:
doi: 10.1097/SLA.0b013e3181ae9d27
Original Articles

Lack of Insurance is Associated With Increased Risk for Hernia Complications

London, Jason A. MD, MPH*; Utter, Garth H. MD, MSc*; Sena, Matthew J. MD*; Chen, Steven L. MD, MBA†; Romano, Patrick S. MD, MPH‡

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Objective: We sought to determine whether lack of insurance is associated with an increased likelihood of presenting to a hospital with a complicated hernia, and whether insurance status might be associated with clinical outcomes.

Context: Delays in elective repair of hernias appear to increase the likelihood of emergency presentation, morbidity, and mortality. Lack of access due to insurance status is a plausible contributor to such delays.

Methods: This retrospective study evaluated ambulatory surgical and inpatient hospitalization data from January 1, 2005 through December 31, 2006 in California. Patients who presented for a inguinal, umbilical, or ventral hernia repair or were hospitalized primarily related to the hernia, were at least 5 years old, and had Medicaid (Medi-Cal in California), Medicare, private, or no insurance were included. The main outcome is presentation with a hernia involving bowel obstruction or gangrene, sepsis, or peritonitis. Secondary outcomes evaluated were inpatient mortality, length of hospital stay, and nonoperative management.

Results: Out of 147,665 encounters involving hernias, 13,254 (9.0%) involved presentation with a complicated hernia. While only 4.7% of encounters among patients with private insurance were for complicated hernias, 21.1% of those for patients without insurance involved complicated hernias (odds ratio [OR]: 7.02, 95% confidence interval [CI]: 5.05–9.76). Uninsured patients experienced greater mortality (OR: 2.30, 95% CI: 1.01–5.24), lengths of hospital stay (incidence rate ratio: 3.34, 95% CI: 2.61–4.26), and were less likely to undergo operative management (OR: 0.16, 95% CI: 0.11–0.22) than those with private insurance.

Conclusions: Lack of insurance is associated with a greater likelihood of presenting with a complicated inguinal, umbilical, or ventral hernia and increased mortality among all patients presenting with hernias at these anatomic sites.

© 2009 Lippincott Williams & Wilkins, Inc.