Dual-Eligible Insurance Status is Associated with Poorer Perioperative Brain Tumor Craniotomy Outcomes. (16th November 2020)

• Record Type: Journal Article
• Authors: Tang, Oliver Y; Rivera Perla, Krissia M; Ruiz, Kiara Corcoran; Toms, Steven A; Weil, Robert J
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_154
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Dual-eligible (DE) patients, enrolled simultaneously in Medicare and Medicaid, have been characterized as a uniquely vulnerable and high-cost population. However, outcomes for DEs are poorly understood for individuals undergoing brain tumor surgery. METHODS: We identified all adult admissions undergoing craniotomy (ICD-9 procedure code 01.14, 01.53, 01.59) for a supratentorial primary brain tumor (ICD-9 diagnosis code 191.0-191.5, 191.8-191.9, 225.0) from 2002 to 2011 in the National Inpatient Sample (NIS). 2011 is the year multiple insurances were last recorded. Admissions were stratified by insurance status into four groups: private insurance, Medicare, Medicaid, or DE. Inpatient mortality, discharge to home, perioperative complications, length of stay (LOS), and costs were analyzed as outcomes. Multivariate regression was used to adjust for 15 confounding variables, including patient, severity, and hospital characteristics. RESULTS: We analyzed 94, 468 total admissions. DEs comprised 2.5% (n = 2, 374) of the population. DEs (mean age = 58.3 years, P < . 001) were younger than Medicare admissions (70.3 years, P < . 001) but older than private insurance (48.5 years, P < . 001) and Medicaid admissions (44.0 years, P < . 001). DEs were more likely to be non-white than Medicare and private beneficiaries (both P < . 001) and presented with higher severity of illness and risk of mortality scores than all other insurance groups (all P < . 001). Following multivariate adjustment, DEs had lower mortality than Medicare admisisons (odds ratio [OR] = 0.43, 95% CI = 0.19-0.96, P = . 038). However, DEs exhibited lower odds of being discharged to home compared to all insurance groups (all P < . 001). Additionally, DEs had higher odds of complications than private (OR = 1.71, 95% CI = 1.31-2.23, P < . 001), Medicare (OR = 1.59, 95% CI = 1.21-2.10, P < . 001), and Medicaid (OR = 1.41, 95% CI = 1.02-1.93, P = . 037) beneficiaries. Finally, DEs had elevated LOS compared to private insurance (+19%, 95% CI = 12-27%, P < . 001) and Medicare (+10%, 95% CI = 3-17%, P = . 004) patients, but there were no significant differences in costs. CONCLUSION: Compared to other insurance groups, dual-eligible admissions exhibited lower rates of discharge home, higher rates of complications, and elevated LOS, even after adjusting for their higher severity on presentation. Further research is needed to identify actionable ways to improve post-operative support and reduce disparities for this vulnerable population.