Abstract：
Background: Lack of insurance is associated with poorer outcomes in hospitalized patients. However, few studies have explored this association in hospitalizations for necrotizing soft tissue infections (NSTIs). This study examined the impact of insurance status on the outcome of NSTI admissions. Methods: All adult hospitalizations for necrotizing fasciitis, gas gangrene, and Fournier gangrene between 2016 and 2018 were examined using the Nationwide Inpatient Sample database. Insurance status was categorized as insured (including Medicare, Medicaid, and Private, including Health maintenance organization (HMO) or uninsured (Self-pay). Outcome measures included mortality rates, limb loss, length of hospital stay, prolonged hospital stay, and critical care admissions. Statistical analysis included weighted sample analysis, chi-square tests, multivariate regression analysis, and negative binomial regression modeling. Results: Approximately 29,705 adult hospitalizations for NSTIs were analyzed. Of these, 57.4% (17,065) were due to necrotizing fasciitis, 22% (6,545) to gas gangrene, and 20.5% (6,095) to Fournier gangrene. Approximately 9.7% (2,875) were uninsured, whereas 70% (26,780) had insurance coverage. Among the insured, Medicare covered 39.6% (10,605), Medicaid 29% (7,775), and private insurance 31.4% (8,400). After adjustments, Medicare insurance was associated with greater odds of mortality (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.33-2.47; p = 0.001). Medicaid insurance was associated with increased odds of amputation (aOR: 1.81; 95% CI: 1.33-2.47; p < 0.001), whereas private insurance was associated with lower odds of amputation (aOR: 0.70; 95% CI: 0.51-0.97; p = 0.030). Medicaid insurance was associated with greater odds of prolonged hospital stay (aOR: 1.34; 95% CI: 1.09-1.64; p < 0.001). No significant association was observed between the lack of insurance or self-pay and the odds of primary or secondary outcomes. Conclusion: Medicare insurance was correlated with greater odds of mortality, whereas Medicaid insurance was associated with increased odds of amputation and longer hospital stay. Uninsured status was not associated with significant differences in NSTI outcomes.
摘要：
背景：缺乏保险与住院患者预后较差有关。然而,很少有研究探讨这种相关性与坏死性软组织感染(NSTIs)住院的关系.这项研究考察了保险状况对NSTI录取结果的影响。方法：所有成人因坏死性筋膜炎住院，气体坏疽,使用全国住院患者样本数据库检查了2016年至2018年之间的Fournier坏疽。保险状态被归类为已投保(包括医疗保险，医疗补助,私人,包括健康维护组织(HMO)或无保险(自付)。结果指标包括死亡率，肢体丧失,住院时间,住院时间延长,和重症监护入院。统计分析包括加权样本分析，卡方检验,多元回归分析，和负二项回归建模。结果：分析了约29,705名NSTIs成人住院治疗。其中,57.4%（17,065）是由于坏死性筋膜炎，22%(6,545)的气体坏疽，20.5%(6095)的Fournier坏疽。大约9.7%(2,875)没有保险，而70%(26,780)有保险。在被保险人中，医疗保险覆盖39.6%(10,605)，医疗补助29%（7,775），私人保险31.4%（8400）。调整后,医疗保险与较高的死亡几率相关(调整后优势比[aOR]:1.81;95%置信区间[CI]:1.33-2.47;p=0.001)。医疗补助保险与截肢几率增加相关(aOR:1.81;95%CI:1.33-2.47;p<0.001),而私人保险与较低的截肢几率相关(aOR:0.70;95%CI:0.51-0.97;p=0.030).医疗补助保险与住院时间延长的可能性更大(aOR:1.34;95%CI:1.09-1.64;p<0.001)。在缺乏保险或自付与主要或次要结果的几率之间没有观察到显着关联。结论：医疗保险与更大的死亡率相关，而医疗补助保险与截肢几率增加和住院时间延长相关.无保险状态与NSTI结果的显着差异无关。
