Abstract
Abstract There is a growing body of evidence demonstrating improved outcomes for patients with CNS neoplasms treated at academic centers (ACs) versus non-academic centers (non-ACs). This represents a potential healthcare disparity within neurosurgery. Herein, we investigate the relationship between facility type and surgical outcomes in meningioma patients. METHODS: The National Cancer Database was queried for adult patients diagnosed with intracranial meningioma requiring intervention between 2004 and 2019. Patients were stratified by facility type and the Mann-Whitney U and Fisher exact tests were used for bivariate analysis of continuous and categorical variables. Multivariable logistic and linear regression were used to assess whether demographic variables predicted treatment at non-ACs. Furthermore, multivariate cox proportion hazard and log-rank tests were used to determine whether facility type was related to overall survival (OS). RESULTS: In total, 314,651 patients diagnosed with meningioma were included; 122,112 (38.8%) patients were treated at an AC and 192,539 patients (61.2%) were treated at a non-AC. On bivariate analysis, patients treated at an AC were more likely to be white (30.7% vs 24.7%, p< 0.001), have an income higher than $63,000 (31.8% vs 29% p< 0.001) and have a larger tumor (43.3±113.6 vs 39.3±106.8, p< 0.001). On multivariate Cox models, the risk of death for patients treated at ACs was 16.7% lower than that of non-AC patients (HR = 0.883, 95% CI 0.858–0.908, p < 0.001). When controlling for demographic and clinical variables, patients treated at ACs were more likely to undergo surgical intervention (OR = 1.059, 95% CI 1.033-1.087, p < 0.001) but less likely to receive radiotherapy (OR = 0.921, 95% CI 0.897-0.947, p < 0.001). CONCLUSIONS: Our results indicate that AC facility type is associated with disparate survival outcomes in treatment of intracranial meningiomas. Namely, patients treated at non-ACs appear to suffer a survival disadvantage.
Published Version
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