Abstract 100P
Background
Public insurance type has been correlated with worse overall survival in several cohorts of cancer patients in the United States, but few analyses included combination insurance as a discreet insurance category. The objective of this study is to determine whether public, private, or combination insurance type predicted 5-year mortality after robotic-assisted pulmonary lobectomy (RAPL) for lung cancer.
Methods
We retrospectively analyzed 711 patients who underwent RAPL from September 2010 to March 2022 by one surgeon.
Results
Among our 711 study patients, 367 (52%) patients had combination insurance, 144 (20%) had public insurance, and 200 (28%) patients had private insurance. There were no differences in sex, race, body mass index, or tumor characteristics including stage, grade, pathology, histology, size and nodal status. Patients with combination insurance had a higher mean age (p < 0.0001), the largest proportion of former smokers (p = 0.0003), higher Charlson comorbidity index scores (p = 0.0014), more comorbid conditions, and the least estimated blood loss during surgery (p = 0.003). There were no differences in hospital length of stay, discharge disposition, and in-hospital or 30-day mortality. Multivariable regression analysis identified combination insurance type as an independent predictor of 5-year all-cause mortality (hazard ratio, 1.72; 95% CI, 1.08–2.75; p = 0.02; table).
Table: 100PMultivariable analysis on predictors of 5-year overall mortality
| Variable | Hazard Ratio (95% CI) | p = value |
|---|---|---|
| Combination Insurance | 1.72 (1.08–2.75) | 0.02 |
| Public Insurance | 1.18 (0.72–1.93) | 0.51 |
| Former Smoker | 0.75 (0.45–1.24) | 0.26 |
| Never Smoker | 0.69 (0.38–1.23) | 0.21 |
| Charlson Comorbidity Index Score | 0.97 (0.76–1.23) | 0.81 |
| Preoperative Chronic Kidney Disease | 4.81 (0.60–38.4) | 0.14 |
| Preoperative Atrial Fibrillation | 1.17 (0.39–3.50) | 0.79 |
| Preoperative Hypertension | 0.95 (0.62–1.46) | 0.82 |
| Preoperative Hyperlipidemia | 1.36 (0.87–2.12) | 0.17 |
| Intraoperatie Estimated Blood Loss | 1.00 (1.00–1.00) | 0.99 |
Conclusions
Although previous studies identified public health insurance as a predictor of worse 5-year overall survival in the United States, in our present cohort, combination insurance type was associated with the greatest risk for all-cause mortality.
Legal entity responsible for the study
The authors.
Funding
University of South Florida Health Morsani College of Medicine.
Disclosure
J.P. Fontaine: Financial Interests, Personal, Training: Intuitive Surgical Corp.
E. Toloza: Financial Interests, Personal, Training: Intuitive Surgical Corp.
All other authors have declared no conflicts of interest.