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

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.