• Brittany N Burton, Angele S Labastide, Minhthy N Meineke, Ulrich H Schmidt, and Rodney A Gabriel.
• School of Medicine, University of California, San Diego, San Diego, CA, USA.
• J Clin Anesth. 2019 May 1; 54: 66-71.

Study ObjectiveSafety-net hospitals disproportionately care for high-risk patients. Prior work has shown safety-net hospitals to have inferior postoperative outcomes with higher cost and worse patient ratings. We aim to examine the association of hospital safety-net burden with morbidity and mortality in patients with opioid overdose hospital admission.DesignRetrospective cross-sectional analysis using the National Inpatient Sample registry from 2010 to 2014.SettingMulti-institutional.PatientsWe included 547, 399 patients admitted to a United States hospital with an International Classification of Disease, Ninth Revision, code of opioid overdose. To study the association of hospital safety-net burden on mortality and morbidity, we calculated hospital safety-net burden defined as the percent of Medicaid or uninsured among all admitted patients. Hospitals were categorized into one of three categories: low burden hospitals, medium burden hospitals, and high burden hospitals (i.e., safety-net hospitals). We performed a mixed effects multivariable logistic regression analysis to assess the association of hospital safety-net burden with short-term inpatient outcomes.InterventionNone.MeasurementsThe primary outcomes were inpatient mortality and morbidity.Main ResultsCompared to MBHs and LBHs, HBHs had a greater proportion of minority patients (i.e., Black, Hispanic, and Native American) and patients with median household income in the lowest quartile (p < 0.001). Among prescription opioid overdose admissions, the odds of inpatient mortality and pulmonary and cardiac morbidity were also not significantly higher between HBHs versus LBHs (p > 0.05).ConclusionsSafety-net hospital disproportionately care for vulnerable populations, however the odds of poor outcomes were no different in opioid overdose. Safety-net hospitals should have equal access to the funding and resources that allows them to deliver the same standard of care as their counterparts.Copyright © 2018 Elsevier Inc. All rights reserved.

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