The Impact of the Affordable Care Act on Urogynecologic Surgery Cancelation Rates

Objectives: We examined the impact of the implementation of the Affordable Care Act (ACA) on female pelvic medicine and reconstructive surgery (FPMRS) surgical cancelation rates. Methods: A retrospective cohort study was performed on patients scheduling FPMRS procedures 1 year before and after ACA implementation at a regional academic medical center. We compared cancelation rates as well as sociodemographic, surgical, and medical history data. Analysis included (2) test, t test, and univariable and multivariable logistic regression. Results: We included 746 subjects, 373 each before and after ACA implementation (January 2014). Subjects were 59.2 +/- 14.0 years old, predominantly white (94.9%), employed (45.8%), and married (66.6%), with a body mass index of 28.8 +/- 6.2. Subjects lived a median of 24 miles from the hospital. None of these were significant predictors of cancelations. Surgery cancelation rate was 17.1% and occurred 9 days before surgery. On univariable analysis, cancelation rates did not differ relative to the ACA (15.5% before vs 18.6% after; mean difference, 3.16%; 95% confidence interval [CI], -2.29% to 8.69%; P = 0.254). Only 3 variables impacted cancelation rate on univariable analysis: women whose surgery was scheduled for later in the week, liver/renal disease, and minor vs major surgery. On multivariable regression including variables with P < 0.20 as candidate variables, the same 3 variables remained significant. Cancelations increased with procedures scheduled later in the week (odds ratio [OR], 1.169 per day; 95% CI, 1.004-1.361) and liver or renal disease (OR, 2.342; 95% CI, 1.015-5.405). Major procedures had fewer cancelations (OR, 0.625; 95% CI, 0.414-0.943). The ACA implementation of still did not impact cancelations (OR, 1.230; 95% CI, 0.831-1.821). Conclusions: The implementation of the ACA did not impact FPMRS cancelation rates. Significant predictors of surgical cancelation included later day of the week, comorbid renal or liver disease, and performance of a minor procedure.