Impact of payer status and hospital volume on outcomes after head and neck oncologic reconstruction

Abstract Background High-volume centers improve outcomes in head and neck cancer (HNCA) reconstruction, yet it is unknown whether patients of all payer status benefit equally. Methods We identified patients undergoing HNCA surgery between 2002 and 2015 using the National Inpatient Sample. Outcomes included receipt of care at high-volume centers, receipt of reconstruction, and post-operative complications. Multivariate regression analysis was stratified by payer status. Results 37,442 patients received reconstruction out of 101,204 patients who underwent HNCA surgery (37.0%). Privately-insured and Medicaid patients had similar odds of receiving high-volume care (OR = 0.99, 95% CI = 0.87–1.11) and undergoing reconstruction (OR = 0.96, 95% CI = 0.86–1.05). Medicaid beneficiaries had higher odds of complication (OR = 1.36, 95% CI = 1.22–1.51). The discrepancy in complication odds was significant at low-volume (OR = 1.44, 95% CI = 1.12–1.84) and high-volume centers (OR = 1.30, 95% CI = 1.15–1.47). Conclusions Medicaid beneficiaries are as likely to receive care at high-volume centers and undergo reconstruction as privately-insured individuals. However, they have poorer outcomes than privately-insured individuals at both low- and high-volume centers.