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

Abstract

INTRODUCTION: Disparities exist in medical care and may result in avoidable negative clinical care outcomes. The role of economics in achieving access to care is well-documented in the literature. However, the impact of social disparities on surgical outcomes after access hurdles have been overcome is poorly characterized. METHODS: 283 consecutive patients undergoing posterior fossa brain tumor resections, excluding cerebellar pontine angle(CPA) tumors, over a six-year period(June 09, 2013-April 26, 2019) at a single, multihospital academic medical center were analyzed retrospectively. Patient characteristics were obtained from the electronic medical record, including median household income, race, BMI, Charlson Comorbidity Index(CCI), and American Society of Anesthesiologists(ASA) grade, amongst others. Outcomes evaluated include 30-day readmission, 30-day emergency department(ED) evaluation, 30-day unplanned reoperation, return to surgery after index admission within 30 days, and mortality within 30 days. Univariate analysis was conducted amongst the entire population with significance set at a P-value < .05. 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-value < .05. Stepwise regression was conducted to determine the correlations amongst study variables and identify confounding factors. RESULTS: Whole population univariate analysis demonstrated lower socioeconomic status to be correlated with increased mortality within 30 post-operative days (P = .03, OR = 1.45, 95% CI = 1.03-2.04) and increased return to surgery after index admission (P = .02, OR = 1.96, 95% CI = 1.10-3.45). No significant difference was found with regards to 30-day readmission (P = .24), ED evaluation (P = .75), or unplanned reoperation (P = .63). Increasing but not significant mortality was demonstrated between Q1 and Q4 socioeconomic quartiles (P = .06, OR = 7.70, 95% CI = 0.89-50.01). CONCLUSION: This study suggests that low socioeconomic status, when defined by household income, correlates with increased mortality within 30 days and 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 provide additional support in the post-operative setting.