Daniela Bresciani Padilla, BA
Gabriela Pomales Díaz, MS
Cristhian G. Negrón Rodríguez, BS
Jayson Cotto Del Valle, BS
Odaly Balasquide Odeh, BS
Guillermo S. López Torres, BS
Ángel J. Carrero Agrón, MS (el punto después de la inicial)
Deyna Morales Carrasquillo, BS
Juan C. Berríos Cordero, BS
Natalia Yordán Fernández, BS
Luis Barreto Hollady, BS
Alejandra Acevedo Muñiz, BS
Corally López, BS
Ángel E. Rivera Barrios, MD, FACS

University of Puerto Rico School of Medicine
Universidad Central del Caribe
Department of Surgery, University of Puerto Rico School of Medicine

Introduction

Health disparities, particularly those related to insurance status, significantly impact trauma outcomes. This study investigates the effects of insurance coverage on outcomes such as length of stay (LOS), survival, and surgical site infections (SSI) in craniomaxillofacial (CMF) trauma patients in Puerto Rico.

Methods

A retrospective analysis was conducted on 1,165 CMF trauma patients treated at the Puerto Rico Medical Center’s Department of Trauma from January 2018 to October 2022. Patients were categorized by insurance status: government-only, private-only, government + private, and uninsured. Statistical analyses, including ANOVA, Chi-square tests, and t-tests, were performed to assess relationships between insurance status and LOS, survival, operative status, and SSI.

Results

Most patients (72.9%) had government insurance, and 8.5% were uninsured. Motor vehicle accidents were the leading cause of injury (49.3%). Uninsured patients had shorter LOS (mean 12.43 days) compared to those with government (20.30 days) or private insurance (16.88 days; p=0.02). Mortality rates were highest among uninsured patients (12.1%), followed by those with government + private insurance (10.0%), government-only insurance (8.8%), and private insurance (6.6%; p=0.02). No significant differences were observed in operative rates (p=0.355) or SSI (p=0.847).

Conclusion

This study highlights disparities in outcomes for CMF trauma patients in Puerto Rico based on insurance status. Government-insured patients have longer LOS but lower mortality, while uninsured patients experience shorter stays and higher mortality, suggesting potential undertreatment. Expanding insurance coverage and improving follow-up care for uninsured populations may help address these disparities.

IRB Approval

2303084772R001, The University of Puerto Rico, Medical Sciences Campus