Impact of primary payer status on outcomes among patients with burn injury: A nationwide analysis

Objective: To study the relationship between insurance provider and important outcomes among patients with burn injury. Methods: Adults with burn injury were selected from the National Inpatient Sample. The primary outcome was inpatient mortality. Secondary outcomes were morbidity (septic shock and prolonged mechanical ventilation (PMV)), treatment metrics (time to surgery and parenteral or enteral nutrition (P/E-nutrition)) and resource utilization (length of stay (LOS) and total hospitalization costs and charges). Confounders were adjusted for using multivariate regression analysis. Results: Insurance did not affect in-hospital mortality rate. Compared with private insurance, Medicaid was associated with higher septic shock rate (aOR: 2.14 (1.04–4.39), longer LOS (adjusted mean difference (aMD): 2.79 (0.50–5.08) days) and higher costs (aMD: $16,161 ($4789–$27,534) while uninsured patients has shorter LOS (aMD: −2.57 (−4.59–−0.55) days), lower charges (aMD: $−37,792 $(−65,550–$−10,034) and costs (aMD: $−8563 ($15,581–$−1544)). Insurance did not affect PMV rates or time to surgery or P/E-nutrition. Conclusions: Primary payer does not affect in-hospital mortality or treatment metrics among patients admitted for burn injury. However, compared with private insurance, Medicaid was associated with both higher morbidity and resource utilization, whereas uninsured patients had lower resource utilization.