• World Neurosurg · Jul 2024

    Socioeconomic and Racial Disparities Impact Access to High Volume Centers During Meningioma Treatment.

    • Diwas Gautam, Matthew C Findlay, and Michael Karsy.
    • Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Neurosurgery, Global Neuroscience Institute, Chester, Pennsylvania, USA.
    • World Neurosurg. 2024 Jul 1; 187: e289e301e289-e301.

    BackgroundStudies examining the relationship among hospital case volume, socioeconomic determinants of health, and patient outcomes are lacking. We sought to evaluate these associations in the surgical management of intracranial meningiomas.MethodsWe queried the National Inpatient Sample (NIS) database for patients who underwent craniotomy for the resection of meningioma in 2013. We categorized hospitals into high-volume centers (HVCs) or low-volume centers (LVCs). We compared outcomes in 2016 to assess the potential impact of the Affordable Care Act on health care equity. Primary outcome measures included hospital mortality, length of stay, complications, and disposition.ResultsA total of 10,270 encounters were studied (LVC, n = 5730 [55.8%]; HVC, n = 4340 [44.2%]). Of LVC patients, 62.9% identified as white compared with 70.2% at HVCs (P < 0.01). A higher percentage of patients at LVCs came from the lower 2 quartiles of median household income than did patients at HVCs (49.9% vs. 44.2%; P < 0.001). Higher mortality (1.3% vs. 0.9%; P = 0.041) was found in LVCs. Multivariable regression analysis showed that LVCs were significantly associated with increased complication (odds ratio, 1.36; 95% confidence interval, 1.30-1.426, P<0.001) and longer hospital length of stay (odds ratio, -0.05; 95% confidence interval, -0.92 to -0.45; P <0.001). There was a higher proportion of white patients at HVCs in 2016 compared with 2013 (67.9% vs. 72.3%). More patients from top income quartiles (24.2% vs. 40.5%) were treated at HVCs in 2016 compared with 2013.ConclusionsThis study found notable racial and socioeconomic disparities in LVCs as well as access to HVCs over time. Disparities in meningioma treatment may be persistent and require further study.Copyright © 2024 Elsevier Inc. All rights reserved.

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