Patients with public insurance were significantly younger ( p < 0.001), more often male ( p < 0.001), and in better general health according to the ASA physical status category ( p < 0.001). In total, 76.8% ( n = 23,196) of the patients were publicly insured. Bi- and multivariate analyses were performed, adjusted for insurance status, age, sex, American Society of Anesthesiologists (ASA) physical status category, type of injury, and surgeon’s level of experience. Secondary outcomes included overall and intra- and postoperative complications. The primary outcome was in-hospital mortality.
In total, 30,175 patients were included for analysis. Missing insurance status information was an exclusion criterion. We included all patients in the AQC database with any S- or T-code diagnosis according to the International Classification of Diseases ICD-10 (any injuries) who were treated during the 11-year period of 2004–2014. More than 80 surgical departments in Switzerland are part of this quality program. We used a prospective national quality assessment database from the Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie (AQC). We sought to gain further insights into differences in the outcomes of trauma patients in a healthcare system with mandatory public health coverage by comparing publicly versus privately insured patients. Most studies comparing uninsured to insured patients were done in the USA. There has been growing evidence in trauma literature that differences in insurance status lead to inequality in treatment and outcome.
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