Introduction: The Society for Vascular Surgery guidelines recommend carotid revascularization within 14 days of symptom onset for neurologically stable stroke patients. However, in the US, insurance status may affect surgical timing, although large-scale studies are lacking. Using the VQI database, we evaluated the impact of insurance status on surgical wait times for patients with symptomatic carotid disease.
Methods: Symptomatic patients undergoing carotid revascularization from 2010-2022 with Modified Rankin score <2 were included. The primary outcome was time from symptom onset to intervention, with patients divided into timely (TC) or late (LC) intervention groups (>14 days). Categorical variables were compared using Chi-square, and one-way ANOVA was used for continuous variables. Multivariable logistic regression assessed the association between insurance status and surgical wait time, adjusting for confounders.
Results: There were 11,973 TC and 21,253 LC patients. LC patients were older, less likely to undergo CEA, and more likely to have elective procedures. After adjusting for confounders, Medicare Advantage (aOR 0.89, 95% CI 0.80-0.99, p=0.03), Commercial (aOR 0.84, 95% CI 0.78-0.90, p<0.001), Military/VA (aOR 0.67, 95% CI 0.54-0.84, p<0.001), and Self-Pay (aOR 0.54, 95% CI 0.45-0.65, p<0.001) had lower odds of delayed CEA/CAS compared to Medicare. Medicaid patients had similar odds to Medicare. Non-US insurance had higher odds (aOR 1.48, 95% CI 1.13-1.95, p=0.005) compared to Medicare.
Conclusion: Medicare, Medicaid, and Non-US insurance patients were more likely to experience surgical delays compared to those with Commercial, Military/VA, and Self-Pay coverage. Further research is needed to explore the causes and impacts of these delays.
Keywords: Carotid Revascularization; Delayed Intervention; Elective Procedures; Insurance Status; Surgical Access; Surgical Wait Times.
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