Racial and Gender Disparities and the Role of Primary Tumor Type on Inpatient Outcomes Following Craniotomy for Brain Metastases

Nuño, Miriam A; Mukherjee, Debraj; Elramsisy, Adam; Nosova, Kristin; Lad, Shivanand P.; Boakye, Maxwell; Yu, John S.; Black, Keith L.; Patil, Chirag G.

doi:10.1245/s10434-012-2353-z

Cited by 38 publications

(30 citation statements)

References 21 publications

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“…On univariate analysis, patients who were uninsured or with Medicare/Medicaid vs. commercial insurance approached significance (13.7 vs. 6.8 months, p = 0.080); however on multivariate analysis, insurance status was no longer a significant predictor of overall survival ( p < 0.49). This lack of significance could be due in part to the number of patients included in our analysis compared to the numbers of patients in publications using registry data that showed a worse mortality in underinsured patients (10, 11), but it may also suggest that the primary drivers of potential health disparity in our patient population may be related to their presentation in a more advanced disease state (potentially with more active extracranial disease, lower PS, etc. ), rather than an inability to receive adequate care following GKRS.…”

Section: Discussionmentioning

confidence: 87%

“…Many factors including tumor histology, control of extracranial disease, and PS impact a patient’s overall survival (8). It has been reported that uninsured and underinsured cancer patients often have delayed diagnosis and inferior outcomes (9–11). Our institutional series is unique in that a larger percentage of our patient population is African-American, on Medicaid or on Medicare compared to previous publications reporting health disparities in patients treated for brain metastases (10, 11).…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported that uninsured and underinsured cancer patients often have delayed diagnosis and inferior outcomes (9–11). Our institutional series is unique in that a larger percentage of our patient population is African-American, on Medicaid or on Medicare compared to previous publications reporting health disparities in patients treated for brain metastases (10, 11). The purpose of this study is to examine the impact of demographic and clinical characteristics on overall survival in patients receiving SRS and to compare our outcomes with peer institutions.…”

Section: Introductionmentioning

confidence: 99%

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A Single-Institution Analysis of 126 Patients Treated with Stereotactic Radiosurgery for Brain Metastases

et al. 2017

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BackgroundThe objective of this study was to report our institutional experience with Gamma Knife® Radiosurgery (GKRS) in the treatment of patients with brain metastases.MethodsRetrospectively collected demographic and clinical data on 126 patients with intracranial metastases were reviewed. The patients in our study underwent GKRS at Vidant Medical Center between 2009 and 2014. Kaplan–Meier curves were used to compare survival based on clinical characteristics for univariate analysis, and a Cox proportional hazards model was used for multivariate analysis.ResultsThe median age of the patient population was 62 years. Medicare patients constituted 51% of our patient cohort and Medicaid patients 15%. The most common tumor histologies were non-small cell lung cancer (50%), breast cancer (12.7%), and melanoma (11.9%). The median overall survival time for all patients was 5.8 months. Patients with breast cancer had the longest median survival time of 9.15 months, while patients with melanoma had the shortest median survival time of 2.86 months. On univariate analysis, the following factors were predictors for improved overall survival, ECOG score 0 or 1 vs. 2 or greater (17.0 vs. 1.8 months, p < 0.001), controlled extracranial disease vs. progressive extracranial disease (17.4 vs. 4.6 months, p = 0.0001), recursive partitioning analysis Stage I vs. II–III (18.2 vs. 6.2 months, p < 0.007), multiple GKRS treatments (p = 0.002), prior brain metastasectomy (p = 0.012), and prior chemotherapy (p = 0.021). Age, ethnicity, gender, previous external beam radiation therapy, number of brain metastases, and hemorrhagic vs. non-hemorrhagic tumors were not predictors of longer median survival time. Number of metastatic brain lesions of 1–3 vs. ≥4 (p = 0.051) and insurance status of Medicare/Medicaid vs. commercial insurance approached significance (13.7 vs. 6.8 months, p = 0.08). On multivariate analysis, ECOG performance status 0–1 (p < 0.001), multiple GKRS treatments (p = 0.003), and control of extracranial disease (p = 0.001) remained significant predictors of survival.ConclusionECOG score, control of extracranial disease, and multiple GKRS treatments are predictors of longer median survival following GKRS in our patient population. GKRS is an effective treatment for brain metastases, but these factors may be considered in patient selection for GKRS.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Single-Institution Analysis of 126 Patients Treated with Stereotactic Radiosurgery for Brain Metastases

et al. 2017

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“…Disparities based on race or ethnicity in neurooncology patients are well documented. 40,41,43 Prior evaluation of the Nationwide Inpatient Sample from 1988 to 2004 by Curry et al has suggested that postoperative disparities may be primarily due to more severe disease on presentation and reduced access to high-volume care. 17 However, these differences in length of hospital stay may also be related to residual confounding, as disparities in outcomes have also been shown to be attributable to a greater number of and more severe comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Dasenbrock

Liu

Devine

et al. 2015

FOC

140

103

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OBJECT Although the length of hospital stay is often used as a measure of quality of care, data evaluating the predictors of extended hospital stay after craniotomy for tumor are limited. The goals of this study were to use multivariate regression to examine which preoperative characteristics and postoperative complications predict a prolonged hospital stay and to assess the impact of length of stay on unplanned hospital readmission. METHODS Data were extracted from the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2013. Patients who underwent craniotomy for resection of a brain tumor were included. Stratification was based on length of hospital stay, which was dichotomized by the upper quartile of the interquartile range (IQR) for the entire population. Covariates included patient age, sex, race, tumor histology, comorbidities, American Society of Anesthesiologists (ASA) class, functional status, preoperative laboratory values, preoperative neurological deficits, operative time, and postoperative complications. Multivariate logistic regression with forward prediction was used to evaluate independent predictors of extended hospitalization. Thereafter, hierarchical multivariate logistic regression assessed the impact of length of stay on unplanned readmission. RESULTS The study included 11,510 patients. The median hospital stay was 4 days (IQR 3-8 days), and 27.7% (n = 3185) had a hospital stay of at least 8 days. Independent predictors of extended hospital stay included age greater than 70 years (OR 1.53, 95% CI 1.28%-1.83%, p < 0.001); African American (OR 1.75, 95% CI 1.44%-2.14%, p < 0.001) and Hispanic (OR 1.68, 95% CI 1.36%-2.08%) race or ethnicity; ASA class 3 (OR 1.52, 95% CI 1.34%-1.73%) or 4-5 (OR 2.18, 95% CI 1.82%-2.62%) designation; partially (OR 1.94, 95% CI 1.61%-2.35%) or totally dependent (OR 3.30, 95% CI 1.95%-5.55%) functional status; insulin-dependent diabetes mellitus (OR 1.46, 95% CI 1.16%-1.84%); hematological comorbidities (OR 1.68, 95% CI 1.25%-2.24%); and preoperative hypoalbuminemia (OR 1.78, 95% CI 1.51%-2.09%, all p ≤ 0.009). Several postoperative complications were additional independent predictors of prolonged hospitalization including pulmonary emboli (OR 13.75, 95% CI 4.73%-39.99%), pneumonia (OR 5.40, 95% CI 2.89%-10.07%), and urinary tract infections (OR 11.87, 95% CI 7.09%-19.87%, all p < 0.001). The C-statistic of the model based on preoperative characteristics was 0.79, which increased to 0.83 after the addition of postoperative complications. A length of stay after craniotomy for tumor score was created based on preoperative factors significant in regression models, with a moderate correlation with length of stay (p = 0.43, p < 0.001). Extended hospital stay was not associated with differential odds of an unplanned hospital readmission (OR 0.97, 95% CI 0.89%-1.06%, p = 0.55). CONCLUSIONS In this NSQIP analysis that evaluated patients who underwent craniotomy for tumor, much of the variance in hospital stay was attributable to baseline patient characteristics, suggesting length of stay may be an imperfect proxy for quality. Additionally, longer hospitalizations were not found to be associated with differential rates of unplanned readmission.

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“…10,22 Nuño et al found that African American patients had a higher inpatient mortality rate than white patients following craniotomy procedures. 15 In 2013, Stone et al demonstrated that African American children had an increased risk of in-hospital death following surgeries. 22 Racial disparities remain when discharge disposition is considered.…”

Section: Discussionmentioning

confidence: 99%

Racial and socioeconomic disparities in outcomes following pediatric cerebrospinal fluid shunt procedures

Attenello¹,

Wen

et al. 2015

PED

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OBJECT Racial and socioeconomic disparities within the US health care system are a growing concern. Despite extensive research and efforts to narrow such disparities, minorities and economically disadvantaged patients continue to exhibit inferior health care outcomes. Disparities in the delivery of pediatric neurosurgical care are understudied. Authors of this study examine the impact of race and socioeconomic status on outcomes following pediatric CSF shunting procedures. METHODS Discharge information from the 2000, 2003, 2006, and 2009 Kids' Inpatient Database for individuals (age < 21 years) with a diagnosis of hydrocephalus who had undergone CSF shunting procedures was abstracted for analysis. Multivariate logistic regression analyses, adjusting for patient and hospital factors and annual CSF shunt procedure volume, were performed to evaluate the effects of race and payer status on the likelihood of inpatient mortality and nonroutine hospital discharge (that is, not to home). RESULTS African American patients (p < 0.05) had an increased likelihood of inpatient death and nonroutine discharge compared with white patients. Furthermore, Medicaid patients had a significantly higher likelihood of nonroutine discharge (p < 0.05) as compared with privately insured patients. CONCLUSIONS Findings in this study, which utilized US population-level data, suggest the presence of racial and socioeconomic status outcome disparities following pediatric CSF shunting procedures. Further studies on health disparities in this population are warranted.

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Racial and Gender Disparities and the Role of Primary Tumor Type on Inpatient Outcomes Following Craniotomy for Brain Metastases

Abstract: Evidence of race and gender disparities in outcomes were found in black patients, especially in black females who underwent surgical resection for brain metastases. These findings highlight an opportunity to reduce the gap of outcome disparities in brain metastasis patients.

Cited by 38 publications

References 21 publications

A Single-Institution Analysis of 126 Patients Treated with Stereotactic Radiosurgery for Brain Metastases

A Single-Institution Analysis of 126 Patients Treated with Stereotactic Radiosurgery for Brain Metastases

Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Racial and socioeconomic disparities in outcomes following pediatric cerebrospinal fluid shunt procedures

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