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  • Racial and Socioeconomic Disparities in Incidence of Mortality and Nonroutine discharge Following Pediatric Cerebrospinal Fluid Shunts

    Final Number:

    Frank Attenello MD MS; Timothy Wen MPH; Alvin Ng BS; Stephanie L Da Silva BA; Steven Y Cen PhD; Erin N. Kiehna MD; Gabriel Zada MD; William J. Mack MD; J. Gordon McComb MD; Mark D. Krieger MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Socioeconomic and racial disparities are a growing concern within the U.S. healthcare system. Despite extensive research and efforts to narrow such disparities, minorities and economically disadvantaged patients exhibit inferior healthcare outcomes. Disparities in the delivery of pediatric neurosurgical care are understudied.

    Methods: This study examines the impact of race and socioeconomic status on outcomes following pediatric cerebrospinal fluid (CSF) shunting procedures. Discharge information from the 2000, 2003, 2006, and 2009 Kids Inpatient Database (KID) for individuals with a diagnosis of hydrocephalus who underwent 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 likelihood of inpatient mortality and routine hospital discharge (to home).

    Results: There were 37,103 hydrocephalus related shunting procedures identified from the 2000, 2003, 2006 and 2009 KID. There were a total of 31,964 (86,149 per 100,000 pediatric admissions) routine discharges and 409 (1,102 per 100,000 pediatric admissions) inpatient deaths resulting from a shunting procedure. Blacks and Asian/Pacific Islanders (p<0.05) had an increased likelihood of inpatient death compared to White patients. Blacks, Hispanics, and Asian/Pacific Islanders (p<0.05) had a lower likelihood of routine discharge. There was also a disparity when comparing payer status. Medicaid patients had a significantly lower likelihood of routine discharge (p<0.05) when compared to privately insured patients.

    Conclusions: This study suggests the presence of racial and SES outcome disparities following pediatric CSF shunting procedures using United Sates population-level data.

    Patient Care: improved awareness of subgroups that require attention in a common neurosurgical procedure

    Learning Objectives: By the conclusion of this session, participants should be able to 1) describe the distribution of ventricular cerebrospinal shunt (CSF) procedures across demographic and economic subgroups across the US. 2) describe the impact of socioeconomic disparities on outcomes in CSF shunting procedures


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