Abstract
Purpose :
A county hospital system provides a unique opportunity to examine corneal transplants in a diverse population. Uninsured patients make up 16.9% of corneal transplant donors but merely 0.8% of corneal transplant recipients. A retrospective, observational study was conducted to examine rates of graft failure amongst uninsured and insured patients who underwent corneal transplantation at the John H. Stroger, Jr. Hospital of Cook County in Chicago, IL. Follow up rates, insurance status, race, and correlation to graft failure were analyzed.
Methods :
A retrospective analysis was performed examining 137 corneal transplants in 116 patients at John H. Stroger, Jr. Hospital of Cook County between 2009 and 2015. Rates of graft failure were compared amongst insured (60.3%) and uninsured (39.7%) patients. Rates of graft failure were compared amongst African American, Hispanic, Caucasian, and Asian patients. Follow up and correlation to graft failure were also examined.
Results :
Follow up was tracked at 6 weeks and 1 year post transplant. 73% of patients were compliant with follow up at postoperative week 6. Of the 27% that missed appointments, 16.2% did not attend any follow up appointments at post transplant week 6. At 1 year, 42.6% of uninsured patients missed >3 appointments and 19.5% of insured patient missed >3 appointments. Graft failure rates were analyzed. 27.1% of grafts failed. 21.8% of failed grafts were in uninsured patients and 31.7% were in insured patients. 7.3% of uninsured patients experiencing graft failure did not follow as recommended in the first 6 postoperative weeks. Of the insured patients with graft failure within this interval, 11.0% missed appointments. At 1 year post transplant, 16.4% of uninsured patients with graft failure missed appointments and 18.3% of insured patients missed appointments. 9.5% of patients required repeat transplants. 36.4% of patients requiring repeat transplant were uninsured while 63.6% were insured. The majority of patients with graft failure were African American (63.6%).
Conclusions :
Follow up was found to be more infrequent in uninsured patients. However this did not correlate with rates of graft failure. The uninsured exhibited a lower rate of rejection in their postoperative course suggesting that insurance status is not a significant risk factor in relation to risk of graft rejection. An increased rate of graft failure was found in African American patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.