Introduction: With amendment of the Affordable Care Act, 2010, rigorous attempts have been made to provide healthcare access to uninsured US population. Despite these efforts, racial disparity in access to primary healthcare and subsequently outcomes following major surgical procedure exists.

Methods: Study Design: In a population-based, observational, cohort study using the HCUP inpatient databases, we assess for any racial disparity in short-term outcomes following surgical resection for 4 intracranial tumor types: gliomas, meningiomas, acoustic neuroma and pituitary lesions. Outcome endpoints: Inpatient mortality, discharge disposition, LOS, cost, and post-operative complications (cardiac; neurological; venous-thromboembolism, hydrocephalus, hyponatremia, wound complications, wound infections). Exposures: Primary exposure of interest is racial differences (Blacks, Hispanics, Asians, others with reference to Caucasians). Statistical methods: For each tumor type, multivariable models are constructed to identify association of race for individual outcomes by adjusting for demographics (age, sex, race, insurance, socioeconomic status); Hospital characteristics (academic status, bedsize, region, provider volume); Comorbidities (Stroke, seizure disorder, NF-2, CAD, hypertension, VHD, coagulopathy, anemia, hypercholesterolemia, COPD, DM & obesity). All models are fitted with generalizing estimating equations using sandwich-covariance matrix estimator to restrict clustering of similar outcomes within hospitals for robust estimates. For missing exposures, a model-based multiple-imputation approach as an alternative to traditional deletion methods was performed. Sensitivity analysis was performed by evaluating the estimates using 1000-bootstrapped replacement samples.

Results: Results: Significant racial disparities for various outcomes for individual tumor types was observed in a multivariable regression analysis. For each outcome, forest plots depicting estimates for all tumor types are plotted for easy interpretation of data.

Conclusions: Conclusion: Our study quantifies the estimates for racial disparity on outcomes in patients undergoing surgeries for 4 intracranial tumors. The data could provide supporting evidence for policy-making in addressing the gap in healthcare access across United States population with diverse ethnicity.

Patient Care: The findings incorporate data from multiple clinical practice settings across diverse geographical locations in the US. Knowing the impact of racial disparity for a particular outcome could help in risk-stratification and vigilant monitoring for a particular outcome (eg DVT or PE) in specific races to improve outcomes.

Learning Objectives: By going through the presentation, the participants: 1.) Would learn about baseline estimates as quantified depicting racial disparity in outcomes, in patients undergoing surgical resection for any of the 4 analyzed brain tumors 2.) Significance of a multi-faceted approach to target under-privileged areas by providing health care access, warranting an inter-play of multitude of factors including dedicated time, efforts, and resources.

References: The findings incorporate data from multiple clinical practice settings across diverse geographical locations in the US. Knowing the impact of racial disparity for a particular outcome could help in risk-stratification and vigilant monitoring for a particular outcome (eg DVT or PE) in specific races to improve outcomes.