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Abstract
Post-operative readmissions following emergency general surgery (EGS) are costly, frequent, and often preventable. While insurance coverage and social determinants of health (SDOH) are known to shape surgical outcomes, few studies directly compare Medicaid and commercially insured patients while accounting for socioeconomic barriers.
A retrospective database of emergency department (ED) admissions at Beth Israel Deaconess Medical Center from 2008 to 2022 was queried to identify patients who underwent EGS procedures using ICD-9 & 10 codes. The following parameters were compared: Demographic (age, race, language), Clinical(length of stay, readmission, Post-Operative complications), and Insurance data were extracted. Statistical analysis was performed using the Chi-square test, sample t-tests with Satterthwaite correction for unequal variances
A total of 6,816 patients undergoing EGS were identified, including 1492 (21.9%) Medicaid and 5,322 (78.1%) privately insured patients. Medicaid patients had a significantly longer mean hospital stay (218.7 ± 361.7 hours) compared to privately insured patients (158.2 ± 247.1 hours), representing an approximate 2.5-day increase in length of stay (t=6.07, p<0.0001). White patients were predominantly privately insured (85.8% vs. 14.2%, p<0.001), while patients identifying as other races were more likely to have Medicaid (38.6% vs 61.4%, p<0.0001). English-speaking patients were primarily privately insured (81.6% vs. 18.4%), whereas non-English speakers were more likely to have Medicaid (66.9% vs. 33.1%, p<0.0001)
Medicaid status and social determinants strongly influence post-operative outcomes in emergency surgery, contributing to higher readmissions, complications, and AMA discharges. These disparities strain hospitals financially, especially safety-net providers, and may worsen with policy changes that disrupt coverage. Targeted interventions addressing social risk factors and care continuity are essential to improve outcomes and reduce system-wide costs.