The Impact of the Affordable Care Act on Urogynecologic Surgery Cancelation Rates.

OBJECTIVES

We examined the impact of the implementation of the Affordable Care Act (ACA) on female pelvic medicine and reconstructive surgery (FPMRS) surgical cancelation rates.

METHODS

A retrospective cohort study was performed on patients scheduling FPMRS procedures 1 year before and after ACA implementation at a regional academic medical center. We compared cancelation rates as well as sociodemographic, surgical, and medical history data. Analysis included χ test, t test, and univariable and multivariable logistic regression.

RESULTS

We included 746 subjects, 373 each before and after ACA implementation (January 2014). Subjects were 59.2 ± 14.0 years old, predominantly white (94.9%), employed (45.8%), and married (66.6%), with a body mass index of 28.8 ± 6.2. Subjects lived a median of 24 miles from the hospital. None of these were significant predictors of cancelations. Surgery cancelation rate was 17.1% and occurred 9 days before surgery.On univariable analysis, cancelation rates did not differ relative to the ACA (15.5% before vs 18.6% after; mean difference, 3.16%; 95% confidence interval [CI], -2.29% to 8.69%; P = 0.254). Only 3 variables impacted cancelation rate on univariable analysis: women whose surgery was scheduled for later in the week, liver/renal disease, and minor vs major surgery.On multivariable regression including variables with P < 0.20 as candidate variables, the same 3 variables remained significant. Cancelations increased with procedures scheduled later in the week (odds ratio [OR], 1.169 per day; 95% CI, 1.004-1.361) and liver or renal disease (OR, 2.342; 95% CI, 1.015-5.405). Major procedures had fewer cancelations (OR, 0.625; 95% CI, 0.414-0.943). The ACA implementation of still did not impact cancelations (OR, 1.230; 95% CI, 0.831-1.821).

CONCLUSIONS

The implementation of the ACA did not impact FPMRS cancelation rates. Significant predictors of surgical cancelation included later day of the week, comorbid renal or liver disease, and performance of a minor procedure.