• Gregory Glauser, Ryan Dimentberg, Kaitlyn Shultz, Scott D McClintock, and Neil R Malhotra.
• Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
• World Neurosurg. 2020 Nov 1; 143: e112-e121.

BackgroundThe impact of household economics on outcomes is not well understood. We examined the relationship of income and surgical outcomes, after controlling for numerous patient characteristics.MethodsConsecutive adult (≥18) patients (n = 1970, June 2013-April 2019) undergoing supratentorial brain tumor resection, at a single health system, were assessed. Univariate logistic regression was performed to assess the impact of household income on patient survival. The cohort was then separated into income quartiles (range: $18,119-$193,152). The lowest (Q1) and highest (Q4) income quartiles were then compared. Patients (Q1/Q4) subsequently underwent 1:1 coarsened exact matching based on a number of patient characteristics. Outcomes included mortality, emergency evaluations, and readmissions.ResultsRegression analysis of all 1970 patients demonstrated increasing survival with increasing household income (mortality 30-day P = 0.027, 90-day P = 0.002). Logistic regression of all Q1 versus Q4 patients (n = 970) demonstrated increased survival for the highest income patients (Q4) (mortality 30-day P = 0.220, 90-day P = 0.028, all follow-up P = 0.027). Analysis of exact-matched patients (Q1 vs. Q4; n = 462), demonstrated higher income was associated with escalating, nonsignificant, survival rates at 30 (mortality 3.90% Q1 vs. 2.60% Q4, P = 0.424) and 90 days (mortality 13.42% Q1 vs. 8.66 Q4, P = 0.101) but significantly increased survival during total follow-up (mortality Q1 46.75%, Q4 35.06%, P = 0.010). No significant difference was noted for the remaining studied outcomes.ConclusionsPatients matched on a multitude of characteristics, of lesser household income, had higher long-term mortality after brain tumor resection. Further understanding of this disparity should be sought and differences mitigated.Copyright © 2020. Published by Elsevier Inc.

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