The Impact of Household Economics on Short-Term Outcomes in a Posterior Fossa Tumor Population.

Abstract

BackgroundDisparities exist in medical care and may result in avoidable negative clinical care outcomes for those affected. There remains a paucity in the literature regarding the impact of economic disparities on neurosurgical outcomes.MethodsA total of 283 consecutive posterior fossa brain tumor resections, excluding cerebellopontine angle tumors, over a six-year period (June 07, 2013, to April 29, 2019) at a single, multihospital academic medical center were analyzed retrospectively. Outcomes evaluated included 30-day readmission and mortality, emergency department (ED) evaluation, unplanned return to surgery within 30 days, and return to surgery after index admission within 30 days. The population was divided into quartiles based on median household income, and univariate analysis was conducted between the lowest (Q1) and highest (Q4) socioeconomic quartiles, with significance set at a p < 0.05. Stepwise regression was conducted to determine the correlations among study variables and identify confounding factors.ResultsWhole population univariate analysis demonstrated lower socioeconomic status (SES) to be correlated with increased mortality within 30 post-operative days and increased return to surgery after index admission. No significant difference was found with regard to 30-day readmission, ED evaluation, unplanned reoperation, or return to surgery after index admission. Decreasing, but not significant, mortality was demonstrated between Q1 and Q4 socioeconomic quartiles.ConclusionsThis study suggests that low SES, when defined by household income, correlates with increased mortality within 30 days and an increased need for return to surgery within 30 days. There may be an opportunity for hospitals and care providers to use SES to proactively identify high-risk patients and test the impact of supports in the post-operative setting.