• World Neurosurg · Jan 2023

    Disparities in decompressive cranial surgery utilization in severe Traumatic Brain Injury patients without a primary extra-axial hematoma: A U.S Nationwide Study.

    • Aoife S Reilly, Ayaz M Khawaja, Ali Basil Ali, Tracy Madsen, Janine Molino-Bacic, Daithi S Heffernan, Mark R Zonfrillo, Henrikas Vaitkevicius, William B Gormley, Saef Izzy, and Shyam S Rao.
    • Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; RCSI, University of Medicine and Health Sciences, Dublin, Ireland. Electronic address: areilly@rcsi.ie.
    • World Neurosurg. 2023 Jan 1; 169: e16e28e16-e28.

    ObjectiveDecompressive craniectomy is recommended to reduce mortality in severe traumatic brain injury (TBI). Disparities exist in TBI treatment outcomes; however, data on disparities pertaining to decompressive craniectomy utilization is lacking. We investigated these disparities, focusing on race, insurance, sex, and age.MethodsHospitalizations (2004-2014) were retrospectively extracted from the Nationwide Inpatient Sample. The criteria included are as follows: age ≥18 years and indicators of severe TBI diagnosis. Poor outcomes were defined as discharge to institutional care and death. Multivariable logistic regression models were used to assess the effects of race, insurance, age, and sex, on craniectomy utilization and outcomes.ResultsOf 349,164 hospitalized patients, 6.8% (n = 23,743) underwent craniectomy. White (odds ratio [OR] = 0.50, 95% confidence interval [CI] = 0.44-0.57; P < 0.001) and Black (OR = 0.45, 95% CI = 0.32-0.64; P = 0.003) Medicare beneficiaries were less likely to undergo craniectomy. Medicare (P < 0.0001) and Medicaid beneficiaries (P < 0.0001) of all race categories had poorer outcomes than privately insured White patients. Black (OR = 1.2, 95% CI = 1.08-2.34; P = 0.001) patients with private insurance and Black (OR = 1.39, 95% CI = 1.22-1.58; P < 0.0001) Medicaid beneficiaries had poorer outcomes than privately insured White patients (P < 0.0001). Older patients (OR = 0.74, 95%, CI = 0.71-0.76; P < 0.001) were less likely to undergo craniectomy and were more likely to have poorer outcomes. Females (OR = 0.82, 95% CI = 0.76-0.88; P < 0.001) were less likely to undergo craniectomy.ConclusionsThere are disparities in race, insurance status, sex, and age in craniectomy utilization and outcome. This data highlights the necessity to appropriately address these disparities, especially race and sex, and actively incorporate these factors in clinical trial design and enrollment.Copyright © 2022 Elsevier Inc. All rights reserved.

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