Race, insurance status, and traumatic brain injury outcomes before and after enactment of the Affordable Care Act.

Abstract:

BACKGROUND:The Affordable Care Act aims to improve patient outcomes. Race/ethnicity and insurance status impact outcomes after traumatic brain injury. We sought to gauge the Affordable Care Act's effect on outcomes after traumatic brain injury, as graded by race/ethnicity and insurance status. METHODS:The National Trauma Data Bank was utilized to identify traumatic brain injury patients before and after the Affordable Care Act. Patient outcomes comprised of hospital duration of stay, in-hospital mortality, discharge to rehabilitation, and surgical procedures. Using regression analysis, we evaluated the impact of race/ethnicity and insurance status on traumatic brain injury outcomes, then compared them before and after the Affordable Care Act. RESULTS:Mortality decreased for blacks (odds ratio = 0.96 [confidence interval 0.83-1.10] to odds ratio = 0.79 [confidence interval = 0.70-0.89], and Hispanics (odds ratio = 1.03 [confidence interval = 0.90-1.17] to odds ratio = 0.79 [confidence interval = 0.70-0.89]). Mortality increased for the uninsured (odds ratio = 1.28 [confidence interval = 1.11-1.47] to odds ratio = 1.40 [confidence interval = 1.24-1.58]). Medicaid patients underwent decreased duration of stay, (coefficient = 2.75 [confidence interval = 2.49-3.02] to coefficient = 2.17, [confidence interval = 1.98-2.37]), discharge to rehabilitation (odds ratio = 1.15, [confidence interval = 1.04-1.26] to odds ratio = 0.95 [confidence interval = 0.87-1.03]), and surgical procedures (odds ratio = 1.28 [confidence interval = 1.13-1.45] to odds ratio = 1.18, [confidence interval = 1.07-1.30]), while mortality remained unchanged. CONCLUSION:After the Affordable Care Act traumatic brain injury mortality decreased for blacks and Hispanics, but increased for the uninsured. Decreasing trends in resource consumption were also evident, especially for Medicaid patients. These results may illustrate altered delivery of care.

journal_name

Surgery

journal_title

Surgery

authors

Moffet EW,Zens TJ,Haines KL,Beems MV,McQuistion KM,Leverson GE,Agarwal SK

doi

10.1016/j.surg.2017.09.006

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

251-258

issue

2

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(17)30610-4

journal_volume

163

pub_type

杂志文章

相关文献

SURGERY文献大全
  • Predictive model for microvascular invasion of hepatocellular carcinoma among candidates for either hepatic resection or liver transplantation.

    abstract:BACKGROUND:Microvascular invasion is the strongest prognostic factor of survival in patients with hepatocellular carcinoma. We therefore developed a predictive model for microvascular invasion of hepatocellular carcinoma to help guide treatment strategies in patients scheduled for either hepatic resection or liver tran...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2019.01.012

    authors: Nitta H,Allard MA,Sebagh M,Karam V,Ciacio O,Pittau G,Vibert E,Sa Cunha A,Cherqui D,Castaing D,Bismuth H,Guettier C,Samuel D,Baba H,Adam R

    更新日期:2019-06-01 00:00:00

  • Cost of surgery in a low-income setting in eastern Uganda.

    abstract:BACKGROUND:Operative interventions have traditionally been seen as expensive; therefore, surgery has been given low priority in global health care planning in low-income countries. A growing body of evidence indicates that surgery can also be highly cost effective in low-income settings, but our current knowledge of th...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2015.01.026

    authors: Löfgren J,Mulowooza J,Nordin P,Wladis A,Forsberg BC

    更新日期:2015-06-01 00:00:00

  • Mapping endocrine surgery: Workforce analysis from the last six decades.

    abstract:BACKGROUND:We analyzed the demographics of high-volume surgeons (HVS) for endocrine operations. METHODS:We characterized HVS by region, specialty, gender, teaching-affiliation, American Association of Endocrine Surgeons (AAES) membership, and decade they entered practice. Providers were general surgeons (GS) and otola...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2015.08.024

    authors: Krishnamurthy VD,Jin J,Siperstein A,Shin JJ

    更新日期:2016-01-01 00:00:00

  • The quality of surgical clerkships.

    abstract::Many of the contours of a surgical clerkship can be designed, implemented, and evaluated with varying degrees of objectivity. The recently established Association for Surgical Education and its expanding membership have performed in an excellent fashion in addressing the objectives, content, process, and evaluation of...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Holden WD

    更新日期:1985-06-01 00:00:00

  • Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit.

    abstract:BACKGROUND:Central line-associated bloodstream infections occur commonly and are a potentially preventable source of morbidity in the critical care setting. The purpose of this study was to find a way to decrease central line-associated bloodstream infections. METHODS:Data were collected from February 1, 2005, to Apri...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2008.06.004

    authors: Galpern D,Guerrero A,Tu A,Fahoum B,Wise L

    更新日期:2008-10-01 00:00:00

  • Correlation between telomerase reverse transcriptase messenger RNA expression and survival of patients with papillary thyroid carcinoma.

    abstract:BACKGROUND:Telomerase reverse transcriptase promoter mutations were recently found to be associated with poorer prognosis in patients with papillary thyroid carcinoma. Correlation between telomerase reverse transcriptase messenger RNA expression and survival of patients with papillary thyroid carcinoma has not been det...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2020.04.054

    authors: Kwon JH,Yi JW

    更新日期:2021-01-01 00:00:00

  • Histocompatibility and liver transplantation.

    abstract:BACKGROUND:The role of histocompatibility between donor and recipient in liver transplant rejection is unclear because of a paucity of data. The influence of human leukocyte antigen (HLA) type on immunologic graft loss was examined for primary liver transplantations performed at this center. METHODS:Immunologic graft ...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Knechtle SJ,Kalayolu M,D'Alessandro AM,Mason B,Pirsch JD,Sollinger HW,Steen DC,Belzer FO

    更新日期:1993-10-01 00:00:00

  • Active immunotherapy of pancreatic cancer with tumor cells genetically engineered to secrete multiple cytokines.

    abstract:BACKGROUND:Vaccination of tumor-bearing animals with tumor cells genetically engineered to secrete cytokines including interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) has been shown to induce effective tumor-specific immune responses capable of inhibiting local and metastatic disease. Previous unsuccessful attemp...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/s0039-6060(96)80285-6

    authors: Clary BM,Coveney EC,Blazer DG 3rd,Philip R,Lyerly HK

    更新日期:1996-08-01 00:00:00

  • Neoadjuvant radiation for clinical T4 colon cancer: A potential improvement to overall survival.

    abstract:BACKGROUND:Resection of T4 colon cancer remains challenging compared to lower T stages. Data on the effect of neoadjuvant radiation to improve resectability and survival are lacking. The purpose of this study is to describe the use and outcomes of neoadjuvant radiation therapy in clinical T4 colon cancer. METHODS:Adul...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2018.06.015

    authors: Hawkins AT,Ford MM,Geiger TM,Hopkins MB,Kachnic LA,Muldoon RL,Glasgow SC

    更新日期:2019-02-01 00:00:00

  • Metastatic melanoma: an unusual cause of obstructive jaundice.

    abstract::We report a patient with malignant melanoma metastatic to the supraampullar portion of the common bile duct. The unique aspects of this case include its clinical presentation masquerading as obstructive jaundice caused by a bile duct tumor and the finding of an isolated solitary recurrence metastatic to the bile duct....

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: England MD,Sarr MG

    更新日期:1990-05-01 00:00:00

  • Palliation of malignant rectal obstruction with self-expanding metal stents.

    abstract:BACKGROUND:Surgical management of patients with metastatic or recurrent rectal cancer remains controversial. Self-expanding metal stents are increasingly used for palliative treatment of advanced tumors, although long-term results are not yet available. METHODS:Between 1996 and 2003, 521 patients underwent surgery for...

    journal_title:Surgery

    pub_type: 临床试验,杂志文章

    doi:10.1016/j.surg.2004.05.043

    authors: Hünerbein M,Krause M,Moesta KT,Rau B,Schlag PM

    更新日期:2005-01-01 00:00:00

  • Laparoscopic versus open adrenalectomy: another look at outcome using the Clavien classification system.

    abstract:BACKGROUND:A laparoscopic approach to adrenalectomy has become the procedure of choice for most adrenal resections. We hypothesized that laparoscopic adrenalectomy is less likely to result in intensive care unit (ICU) level complications or death than open adrenalectomy, despite baseline comorbidity mix. METHODS:Using...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2012.08.020

    authors: Eichhorn-Wharry LI,Talpos GB,Rubinfeld I

    更新日期:2012-12-01 00:00:00

  • Rapid restoration of bone mass after surgical management of hyperthyroidism: A prospective case control study in Southern India.

    abstract:CONTEXT:The rate and the extent of bone remineralization at cancellous versus cortical sites after treatment of hyperthyroidism is unclear. Few studies have examined the effect of operative management of hyperthyroidism on recovery of bone mass. OBJECTIVE:To evaluate prospectively the bone mineral density (BMD), bone ...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2015.10.002

    authors: Karunakaran P,Maharajan C,Mohamed KN,Rachamadugu SV

    更新日期:2016-03-01 00:00:00

  • Hyperamylasemia: a result of intracranial bleeding.

    abstract::The unexpected finding of hyperamylasemia in a patient with isolated head injury prompted a study of amylase levels in patients with various degrees of cranial trauma. None of seven patients with isolated maxillofacial trauma had hyperamylasemia. This group was studied to discount injury to salivary glands as a source...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Bouwman DL,Altshuler J,Weaver DW

    更新日期:1983-08-01 00:00:00

  • Impact of therapeutic regional lymph node dissection for medullary carcinoma of the thyroid gland.

    abstract:BACKGROUND:Medullary carcinoma of the thyroid gland (MCT) is a disease commonly associated with regional metastases. Apart from surgical resection, there are limited therapeutic options for such patients. Given the variable and often prolonged survival of such patients, the benefit of surgical resection is difficult to...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Ellenhorn JD,Shah JP,Brennan MF

    更新日期:1993-12-01 00:00:00

  • Lymph node evaluation is associated with improved survival after surgery for early stage gallbladder cancer.

    abstract:BACKGROUND:Guidelines for the current National Comprehensive Cancer Network recommend radical cholecystectomy, including hepatic resection and portal lymph node (LN) dissection, for patients with early stage gallbladder (GB) cancer. We sought to determine the survival benefit conferred by adequate LN evaluation. METHO...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2009.06.056

    authors: Jensen EH,Abraham A,Jarosek S,Habermann EB,Al-Refaie WB,Vickers SA,Virnig BA,Tuttle TM

    更新日期:2009-10-01 00:00:00

  • "Take the Volume Pledge" may result in disparity in access to care.

    abstract:BACKGROUND:"Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. METHODS:Using the Healthcare Cost and Utiliza...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2016.07.017

    authors: Blanco BA,Kothari AN,Blackwell RH,Brownlee SA,Yau RM,Attisha JP,Ezure Y,Pappas S,Kuo PC,Abood GJ

    更新日期:2017-03-01 00:00:00

  • Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback.

    abstract:BACKGROUND:We carried out a prospective, randomized, 4-arm study including control arm, blinding of examiners to determine effectiveness of computer-based video instruction (CBVI) and different types of expert feedback (concurrent and summary) on learning of a basic technical skill. METHODS:Using bench models, partici...

    journal_title:Surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.surg.2006.09.012

    authors: Xeroulis GJ,Park J,Moulton CA,Reznick RK,Leblanc V,Dubrowski A

    更新日期:2007-04-01 00:00:00

  • Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer.

    abstract:BACKGROUND:The presence or absence of lymph node metastases is known to be an important prognostic factor for patients with pancreatic cancer. Few studies have investigated the ratio of the number of lymph nodes harboring metastatic cancer to the total number of lymph nodes examined (lymph node ratio [LNR]) with regard...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2006.12.013

    authors: Pawlik TM,Gleisner AL,Cameron JL,Winter JM,Assumpcao L,Lillemoe KD,Wolfgang C,Hruban RH,Schulick RD,Yeo CJ,Choti MA

    更新日期:2007-05-01 00:00:00

  • Time course and variability of the endocrine and metabolic response to severe sepsis.

    abstract:BACKGROUND:In trauma patients a specific pattern of the hormone endocrine response to injury has been described. Conflicting data exist regarding the hormonal changes during sepsis. We studied the time course and variability of the hormonal and metabolic responses to severe sepsis in twelve medical patients. METHODS:H...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Voerman HJ,Groeneveld AB,de Boer H,Strack van Schijndel RJ,Nauta JP,van der Veen EA,Thijs LG

    更新日期:1993-11-01 00:00:00

  • Effects of steroid withdrawal on long-term renal allograft recipients with posttransplantation diabetes mellitus.

    abstract:BACKGROUND:Posttransplantation diabetes mellitus (PTDM), a common complication of current immunosuppressive regimens, has been attributed to the diabetogenic effects of prednisone and cyclosporine. We report our experience with steroid withdrawal (SW) in renal allograft recipients with PTDM. METHODS:SW was attempted o...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Fabrega AJ,Cohan J,Meslar P,Pollak R

    更新日期:1994-10-01 00:00:00

  • Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy.

    abstract:BACKGROUND:The long-term outcome of bilateral adrenalectomy in the management of patients with Cushing's syndrome has not been previously well studied. METHODS:We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fourteen presented with occult or metastati...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Zeiger MA,Fraker DL,Pass HI,Nieman LK,Cutler GB Jr,Chrousos GP,Norton JA

    更新日期:1993-12-01 00:00:00

  • Adenoviral transfer of the inducible nitric oxide synthase gene blocks endothelial cell apoptosis.

    abstract:BACKGROUND:We have previously reported that vascular inducible nitric oxide synthase (iNOS) gene transfer inhibits injury-induced intimal hyperplasia in vitro and in vivo. One mechanism by which NO may prevent intimal hyperplasia is by preserving the endothelium or promoting its regeneration. To study this possibility ...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/s0039-6060(97)90016-7

    authors: Tzeng E,Kim YM,Pitt BR,Lizonova A,Kovesdi I,Billiar TR

    更新日期:1997-08-01 00:00:00

  • Vascular compression of the duodenum: Presentation of ten cases and review of the literature.

    abstract::Ten cases of vascular compression of the duodenum are presented, and 125 cases in the literature since 1962 are reviewed. More common in women than in men, the lesion may result from supine immobilization, wearing body cast, or a rapid weight loss. In about one third of the patients, no predisposing factor can be foun...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Akin JT Jr,Gray SW,Skandalakis JE

    更新日期:1976-05-01 00:00:00

  • Aerosolized cyclosporine as single-agent immunotherapy in canine lung allografts.

    abstract::Current systemic immunosuppressive regimens are unable to prevent lung allograft rejection consistently and are associated with significant morbidity and death. Acute rejection has occurred in 40% and chronic rejection in 50% of our lung recipients. We hypothesized that regional immunotherapy with aerosolized cyclospo...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Dowling RD,Zenati M,Burckart GJ,Yousem SA,Schaper M,Simmons RL,Hardesty RL,Griffith BP

    更新日期:1990-08-01 00:00:00

  • Solid pseudopapillary neoplasm of the pancreas: distinct patterns of onset, diagnosis, and prognosis for male versus female patients.

    abstract:BACKGROUND:Solid pseudopapillary neoplasm of the pancreas is a distinctive pancreatic neoplasm with low metastatic potential. This study examines clinical differences and prognosis between male and female patients. METHODS:The medical records of 34 consecutive patients with pancreatic solid pseudopapillary neoplasms b...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2007.07.030

    authors: Machado MC,Machado MA,Bacchella T,Jukemura J,Almeida JL,Cunha JE

    更新日期:2008-01-01 00:00:00

  • Incidence and management of complications after injection sclerotherapy: a ten-year prospective evaluation.

    abstract::The incidence and management of complications of injection sclerotherapy are reviewed in 304 consecutive patients with esophageal varices followed up prospectively for a 10-year period. The 304 patients were injected on 1336 occasions. Three hundred eleven local esophageal complications occurred in 140 patients (compl...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Kahn D,Jones B,Bornman PC,Terblanche J

    更新日期:1989-02-01 00:00:00

  • Long-term follow-up of glucose tolerance function after pancreaticoduodenectomy: comparison between pancreaticogastrostomy and pancreaticojejunostomy.

    abstract:BACKGROUND:The objectives of the present study are to determine the long-term changes in glucose tolerance function after pancreaticoduodenectomy and to compare the effects of pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Patients and methods The present study consisted of 51 patients who received a panc...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2004.01.006

    authors: Ishikawa O,Ohigashi H,Eguchi H,Yokoyama S,Yamada T,Takachi K,Miyashiro I,Murata K,Doki Y,Sasaki Y,Imaoka S

    更新日期:2004-09-01 00:00:00

  • Gastroprotective actions of bombesin, L-DOPA, and mild irritants: roles of prostaglandins and sensory neurons.

    abstract:BACKGROUND:Bombesin and dopamine prevent gastric injury by an unknown mechanism. Sensory neurons and endogenous prostaglandins play an important role in gastric mucosal defense. This study was designed to assess the role of these two local defense mechanisms in bombesin and dopamine-induced gastroprotection, as well as...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Mercer DW,Cross JM,Castaneda AA,Gunter JA

    更新日期:1998-11-01 00:00:00

  • Extrathoracic axillary-iliac bypass substitution of a resected descending thoracic aorta.

    abstract::Resection of a dissecting aneurysm of the descending thoracic aorta (Type III) was accomplished in a uremic patient on hemodialysis with reconstruction of blood flow through extrathoracic bilateral axillary-subclavian-iliac Dacron grafts. Review of the literature revealed no similar operation reported before. Other po...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Absolon KB,Freant L,Newsome D,Kim SC,Oboler A

    更新日期:1975-02-01 00:00:00