Colorectal Cancer Surgery Outcomes for Vulnerable Patients in Safety-net versus Non-safety-net Hospitals

Extensive research documents disparities in health outcomes for vulnerable populations. Safety-net hospitals those that serve a greater proportion of vulnerable patients with Medicaid or no insurance may yield better outcomes for these vulnerable patients because of their expertise with this population. National Inpatient Sample data from 2005-2007 show that predicted rates of complications following colorectal cancer surgery are approximately 20% lower for vulnerable patients in safety-net than in non-safety-net hospitals (0.273 versus 0.340; 95% CI for the difference: -0.11, -0.001). Differences by safety-net status for Medicare and privately-insured patients were smaller and not statistically significant. The lower complication rates are not due to earlier discharge, as vulnerable patients had significantly longer stays at safety-net hospitals (1.79 days; 95% CI 0.13, 3.40). Additional research is needed to determine whether improvement in post-operative outcomes is due to the expertise of safety-net hospitals in caring for patients with Medicaid or no insurance.