Introduction: Healthcare disparities remain a widespread societal and health policy issue. We investigated racial disparities among an otherwise homogenous cohort of post-operative Medicaid patients with meningioma or malignant/benign/metastatic brain tumors.
Methods: We used the Medicaid component of the MarketScan database (2000-2009) to primarily compare Caucasians and African-Americans undergoing craniotomy for primary or metastatic brain tumors. Univariate and multivariate analyses assessed death, 30-day post-operative complications, adverse discharge disposition, length of stay (LOS), and adjust total charges.
Results: Our study identified 2,321 patients. A majority were Caucasian (73.7%) and female (57.9%) with Charlson comorbidity scores <3 (56.2%) and treated at low-volume centers (73.4%). Approximately 26.3% were African-American; 22.1% had meningiomas. Inpatient mortality was 2.0%, mean LOS was 9 days, mean adjusted total charges were $42,422, adverse discharge disposition occurred in 22.5%, and the 30-day complication rate was 23.35%.
In bivariate analysis of all tumor types, African-Americans had significantly longer LOS (3 additional days, p<0.001), higher charges ($17,356, p<0.001), and complication rates 3.7% higher (p=0.04) than Caucasian counterparts. While similar trends were noted across tumor types, meningioma patients showed the widest racial disparities.
In multivariate analysis, African-Americans with meningiomas had higher odds of developing a complication (p=0.05), having greater LOS (p<0.001), and incurring higher charges (p<0.001) than Caucasians. The presence of one complication doubled both LOS and total charges, while two complications tripled both LOS and total charges.
Conclusions: African-Americans had significantly higher post-operative complications than Caucasians within a relatively homogenous Medicaid population with similar access to care and of similar socioeconomic background. This higher rate of complications drove greater healthcare utilization, including greater LOS and total charges, among African-Americans. Interventions aimed at reducing complications among African-American brain tumor patients may help reduce post-operative disparities and improve the cost-effectiveness of brain tumor surgery.
Patient Care: Disparities in care have been well-document throughout the medical literature but have been incompletely described within the neurosurgical literature. This study documents the deep health care disparities evident within an otherwise homogenous subset of operative brain tumor patients. Furthermore, this study focuses the clinican and policymaker upon complication avoidance as the single greatest predictor of outcome disparities among neurosurgical brain tumor patients with primary or metastatic disease.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Describe the specific disparities seen in short- and long-term outcomes among brain tumor patients undergoing craniotomy for primary versus metastatic disease as well as between different racial subsets.
2. Identify complication avoidance as the greatest predictor of short- and long-term outcomes among post-operative brain tumor patients of varying race and tumor subtypes.
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