Introduction: While prior literature evaluating patients from the turn of the twenty-first century has identified disparities in access to and outcomes after craniotomy for tumor in the United States, few studies have evaluated temporal trends in disparities in recent patient populations.
Methods: Patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry (2011-2014), and stratified by race or ethnicity (non-Hispanic Caucasian, African-American, Hispanic, and Asian or other race). Multivariable logistic regression evaluated the association of race and ethnicity with thirty-day adverse events (death, neurologic or medical complications, readmission, or reoperation) and nonroutine hospital discharge (other than to home). Covariates included age, sex, tumor histology and location, American Society of Anesthesiologists classification, functional status, comorbidities (including hypertension and diabetes), and preoperative laboratory values.
Results: Within the patient population (n=14,184), the adjusted odds ratio (aOR) of a an adverse event was significantly higher for African-American (OR=1.24, 95% confidence interval (CI)=1.05-1.46, p=0.01) and Asian or other race patients (aOR=1.29, 95% CI=1.03-1.51, p=0.03), but not different for Hispanic ethnicity patients (aOR=1.05, 95% CI=0-.88-1.27, p=0.58) compared to non-Hispanic Caucasian patients. Although there was a decrease in the odds of an adverse event for African-American patients between 2011 and 2012, the odds increased between 2012-2014. Additionally, African-American race was associated with greater adjusted odds of a nonroutine hospital discharge (aOR=1.49, 95% CI=1.26-1.77, p<0.001), the effect size and significance of which increased over time (2011 aOR=1.41, p=0.54; 2012 aOR=1.39, p=0.10; 2013 aOR=1.59, p=0.005; 2014 aOR=1.61, p=0.001).
Conclusions: In this NSQIP analysis evaluating a contemporary national patient population, disparities in adverse events and discharge disposition persisted and are increasing over time for African-American patients, after accounting for preoperative clinical confounding variables including comorbidities. Future prospective comparative effectiveness studies will be needed to evaluate interventions that may mitigate these differences in outcomes.
Patient Care: This study identifies temporal trends revealing that disparities in outcomes by race after craniotomy for tumor are continuing to increase, despite adjusting for preoperative confounding variables. Further evaluating of these interventions that may mitigate these disparities are essential to bridge the gap in outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to 1) describe the trends in disparities by race after craniotomy for tumor and 2) discuss future research which may be identify interventions to minimize such disparities.