The Impact of Household Economics on Short-Term Outcomes in a Posterior Fossa Tumor Population

Abstract

Background Disparities exist in medical care and may result in avoidable negative clinical care outcomes for those affected. There remains a paucity in the literature regarding the impact of economic disparities on neurosurgical outcomes. Methods A total of 283 consecutive posterior fossa brain tumor resections, excluding cerebellopontine angle tumors, over a six-year period (June 07, 2013, to April 29, 2019) at a single, multihospital academic medical center were analyzed retrospectively. Outcomes evaluated included 30-day readmission and mortality, emergency department (ED) evaluation, unplanned return to surgery within 30 days, and return to surgery after index admission within 30 days. The population was divided into quartiles based on median household income, and univariate analysis was conducted between the lowest (Q1) and highest (Q4) socioeconomic quartiles, with significance set at a p < 0.05. Stepwise regression was conducted to determine the correlations among study variables and identify confounding factors. Results Whole population univariate analysis demonstrated lower socioeconomic status (SES) to be correlated with increased mortality within 30 post-operative days and increased return to surgery after index admission. No significant difference was found with regard to 30-day readmission, ED evaluation, unplanned reoperation, or return to surgery after index admission. Decreasing, but not significant, mortality was demonstrated between Q1 and Q4 socioeconomic quartiles. Conclusions This study suggests that low SES, when defined by household income, correlates with increased mortality within 30 days and an increased need for return to surgery within 30 days. There may be an opportunity for hospitals and care providers to use SES to proactively identify high-risk patients and test the impact of supports in the post-operative setting.

Socioeconomic Status Predicts Short-Term Emergency Department Utilization Following Supratentorial Meningioma Resection

“…Finally, a stepwise regression model, incorporating other recorded patient demographic variables, was used to identify potential confounders. For outcomes that had less than 5% of events occur (30-day reoperation and mortality), a Firth correction was applied to eliminate the small sample size bias This statistical analysis has previously been described by the present authors [ 1 , 5 , 13 ]. Significance for all analyses was set at a p-value < 0.05.…”

“…In the surgical setting, SES has been previously demonstrated to predict postoperative outcomes across a wide range of populations. Within neurosurgery, previous studies have shown that low SES puts patients at risk for complications following multiple different procedures, from brain tumor resection to spinal surgery [ 1 - 5 ]. Given its broad impact, it, therefore, remains important to evaluate SES and identify outcome disparities in specific neurosurgical procedural populations.…”

Social Determinants of Health and Neurosurgical Outcomes: Current State and Future Directions

“…Serial studies were performed to assess the role of household income and disparities in outcomes following resection of meningiomas (n = 351), nonpituitary, nonmeningioma, parenchymal brain tumors (n = 1970), posterior fossa tumors (n = 283), and CPA tumors (n = 277) over a 6-yr period (June 7, 2013, through April 29, 2019). [41][42][43][44][45] For the purpose of isolating the impact of SES on outcomes, patients of differing SES were matched based on gender assigned at birth and race, among other key criteria. Analysis of the supratentorial brain tumor resection cohort found that postoperative mortality increases with decreasing income (Figure 4).…”

“…42,43 Escalating morbidity was shown with lower SES following resection of both meningiomas and CPA tumors. 42,44,45…”

Assessment of Gender Disparities in Short-Term and Long-Term Outcomes Following Posterior Fossa Tumor Resection

“…Given the high rates of morbidity and surgical complications, the identification of SDOH that contribute to unfavorable outcomes following posterior fossa tumor resection is needed. Previous evidence in this population has confirmed that socioeconomic status contributes to adverse postsurgical events, but no studies yet have examined gender [ 21 ]. Here, we model the effects of gender on short-term and long-term outcomes across our broad population of posterior fossa tumor resection patients.…”