Dane J. Genther, M.D., and Christine G. Gourin, M.D., M.P.H., from Johns Hopkins University in Baltimore, examined the correlation between safety-net hospital care and short-term outcomes after surgery for head and neck cancer. The safety-net burden was calculated from the Nationwide Inpatient Sample database as the percentage of patients with head and neck cancer with Medicaid or no insurance.

The researchers found that, from 2001 to 2008, 123,662 patients underwent surgery. Patients were significantly more likely to be admitted urgently or emergently (odds ratio [OR], 1.54), undergo major surgical procedures (OR, 1.24), have advanced comorbidity (OR, 1.35), and be black (OR, 1.70), and were significantly less likely to be elderly (OR, 0.66) at high-safety-net burden hospitals. After controlling for all other variables, including hospital volume status, there was no association between safety-net burden and in-hospital mortality, acute medical complications, surgical complications, or hospital-related costs. Safety-net burden was significantly associated with a mean increase in length of hospitalization of 24 hours.

"Our data suggest that safety-net hospitals provide head and neck cancer surgical care to a vulnerable population, without an increase in short-term mortality, morbidity, or costs, despite the fact that hospitals with a high-safety-net burden were more likely to care for patients who are black, admitted urgently, have advanced comorbidity, and require more extensive surgery," the authors write.

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