Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study

Findlay, Matthew C.; Bauer, Sawyer Z.; Khan, Majid; Kim, Robert B.; Park, Seojin; Alexander, Hepzibha; Karsy, Michael

doi:10.1227/neu.0000000000002397

Cited by 2 publications

(5 citation statements)

References 26 publications

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“…In the current study, the complication rate was 33%, with a mortality of 4.2%, which is in accordance with previous literature reports. Some recent studies have utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to analyze the complications; however, this database does not record surgical-specific complications for each procedure, like cranial nerve injury, CSF leaks, postoperative hematomas, or visual deficits [ 17 - 18 ]. Studies using the NSQIP database focus more on systemic complications, hospital length of stay, unplanned intubations, and ventilator dependence, therefore underestimating the overall complication rate [ 17 - 18 ].…”

Section: Discussionmentioning

confidence: 99%

Complications After Open Skull Base Surgery for Brain Tumors: A 26-Year Experience

De Jesus

2023

Cureus

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Introduction: Open skull base surgery carries the risk of significant complications. It is important to inform patients and family members clearly of the details of these complications. This study aimed to present the numerous complications encountered with open skull base surgery for brain tumors. This report analyzed the complications experienced by patients treated with open skull base surgery by a single skull base surgeon at a single tertiary center over 26 years. Methods: A retrospective study was performed using the University of Puerto Rico Neurosurgery database to identify patients who were managed using open skull base procedures from 1995 to 2020. The neurosurgical database for each patient had been prospectively recorded. Patients with skull base tumors under the author's care during the study period were included in the investigation. Exclusions include patients with non-tumoral conditions and non-skull base tumors and those operated using a microscopic transsphenoidal route. Patients who experienced an intraoperative or postoperative complication within 30 days of the surgery were further analyzed. Results: In the cohort, 141 patients with brain tumors underwent open skull base surgery. The cohort had a median age of 48 (range 3-79). It consisted of 101 (71.6%) females and 40 (28.4%) males, with a female-to-male ratio of 2.5:1. The approach most frequently used was an orbitofrontal craniotomy (with or without zygomatic osteotomy) in 79 patients (56%). A petrosal approach was utilized in 26 patients (18%). Forty-six patients (33%) developed an intraoperative or postoperative complication. Twenty-four percent of the complications occurred in the 30-day postoperative period. Five patients had more than one complication. The median age of the patients who experienced a complication was 44.5 (range 22-79), with a female-to-male ratio similar to the entire cohort. Cranial nerve injury was the most frequent complication. Worsening or loss of vision in the affected eye occurred in 5.7% of the patients. A cerebrospinal fluid leak occurred in 2% of the patients. Six patients died, two of them after a massive myocardial infarction. Conclusions: The results of this study showed that approximately one-third of the patients undergoing open skull base surgery can develop a complication. The most frequent complication was injury to a cranial nerve. A large number of complications occurred intraoperatively. The majority of the complications in patients with tumors in the posterior fossa were associated with injury to a cranial nerve. At the middle fossa, damage to the optic nerves is a noteworthy complication. Complications at the anterior fossa involved worsening of vision or myocardial infarction. Less aggressive surgery near the cavernous sinus and the petroclival region may reduce complications. Understanding the complications can help counsel patients and family members.

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Section: Discussionmentioning

confidence: 99%

Complications After Open Skull Base Surgery for Brain Tumors: A 26-Year Experience

De Jesus

2023

Cureus

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“…26 Findlay et al observed longer length of stay (LOS) and fewer relative value units in minorities. 24 Tiwari et al demonstrated a higher DI incidence in Hispanic patients and those living in disadvantaged neighborhoods. 27 Haldar et al demonstrated that although Black patients had higher rates of postoperative emergency visits compared with White patients, they had comparable rates of readmission and reoperation.…”

Section: Postoperative Course and Outcomementioning

confidence: 98%

“…Six studies utilized the United States National Cancer Database (NCDB), [13][14][15][16][17][18] while 4 relied on Surveillance, Epidemiology, and End Results (SEER) programs. 13,[19][20][21] Two studies made use of the National Inpatient Sample (NIS) database, 22,23 and other studies used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 24 and the Statewide Planning and Research Cooperative System (SPARCS) database from the New York State Department of Health. 25 The Gantt chart demonstrates the temporal overlap between the included studies (Fig.…”

Section: Study Characteristicmentioning

confidence: 99%

“…High-volume hospital, 22 private hospital, 26 RVU 24 High-volume hospital, 22,26 private hospital 33 High-volume hospital 22 High-volume hospital, 17,22 academic hospital 15…”

Section: Admissionmentioning

confidence: 99%

“…Surgery rate,* 13,14,18,19,21 adenoma size, 19 endoscopic to nonendoscopic 16 Surgery rate, 14,18,21 adenoma size, 33 endoscopic to nonendoscopic 16 Surgery rate 13 Surgery rate, [13][14][15]18 other treatments 15 Postop course CSFL, 23 DI, 26 LOS, 17,24 stroke, 24 discharge to home 24 Nonendocrine complications, 23 electrolyte abnormalities, 23 steroid at discharge, 33 CSFL, 33 LOS 17 None DI 23,27 Hospital charges Based on Wells et al 12 An asterisk (*) indicates items in the NOS quality assessment tool that are awarded a point.…”

Section: Surgicalmentioning

confidence: 99%

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Healthcare disparities in pituitary surgery: a systematic review

Sabahi,

Maroufi,

Wierzbicka

et al. 2023

Neurosurgical Focus

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OBJECTIVE Pituitary surgery is a frequent neurosurgical procedure for the management of pituitary adenomas, but little research has been done on the impact of healthcare disparities on surgical results. Healthcare inequity/disparity in terms of race and socioeconomic status (SES), in addition to age and gender, was evaluated in this study to see if they affect the results of pituitary surgery. METHODS A systematic literature search was carried out utilizing the MEDLINE (PubMed), Web of Science, Scopus, and Embase electronic databases from conception to 2023. The Newcastle-Ottawa Scale was used for quality assessment of the included studies. RESULTS Twenty-one studies yielded a total of 381,643 patients, and removal of the studies with temporal overlap resulted in 134,832 patients with a mean ± SD age of 51.52 ± 0.41 years. Based on the available data, 46.63% of patients were male. Black patients were more likely to be recommended against surgery, while Asian or Pacific Islander patients were more likely to be recommended for surgery. Postoperative course and outcome showed mixed results, with some studies reporting higher rates of transient diabetes insipidus and stroke in racial minority populations. Private hospitals admitted more White patients, and certain racial groups had reduced access to high-volume centers. SES disparities were assessed in terms of insurance and income. Patients with government insurance or without insurance were more likely to be recommended active surveillance instead of definitive treatment. Furthermore, high SES was associated with a higher likelihood of receiving surgical treatment, better treatment outcomes, and better access to high-volume centers. In terms of age and gender disparity, older patients and females were less likely to be recommended for surgical treatment. Age and gender did not consistently impact postoperative course and treatment outcomes, with varying results across studies. No significant age and gender disparities were observed in hospital admissions and charges. CONCLUSIONS This study revealed the presence of disparities in pituitary adenoma surgery based on race, SES, age, and gender. These disparities highlight the need for further research and interventions to ensure equitable access to appropriate surgical treatment and improved outcomes for all patients with pituitary adenomas.

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Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study

Cited by 2 publications

References 26 publications

Complications After Open Skull Base Surgery for Brain Tumors: A 26-Year Experience

Complications After Open Skull Base Surgery for Brain Tumors: A 26-Year Experience

Healthcare disparities in pituitary surgery: a systematic review

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