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J Neurol Surg B Skull Base 2021; 82(06): 631-637
DOI: 10.1055/s-0040-1715590
Original Article

The Influence of Household Income on Survival following Posterior Fossa Tumor Resection at a Large Academic Medical Center

Rachel Blue
1   Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Donald K. Detchou
1   Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Ryan Dimentberg
1   Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Kaitlyn Shultz
2   Department of Mathematics, West Chester University of Pennsylvania, West Chester, Pennsylvania, United States
,
Michael Spadola
1   Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Scott D. McClintock
2   Department of Mathematics, West Chester University of Pennsylvania, West Chester, Pennsylvania, United States
,
Neil R. Malhotra
1   Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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Abstract

Objectives The present study examines the effect of median household income on mid- and long-term outcomes in a posterior fossa brain tumor resection population.

Design This is a retrospective regression analysis.

Setting The study conducted at a single, multihospital, urban academic medical center.

Participants A total of 283 consecutive posterior fossa brain tumor cases, excluding cerebellar pontine angle tumors, over a 6-year period (June 09, 2013–April 26, 2019) was included in this analysis.

Main Outcome Measures Outcomes studied included 90-day readmission, 90-day emergency department evaluation, 90-day return to surgery, reoperation within 90 days after index admission, reoperation throughout the entire follow-up period, mortality within 90 days, and mortality throughout the entire follow-up period. Univariate analysis was conducted for the whole population and between the lowest (Q1) and highest (Q4) socioeconomic quartiles. Stepwise regression was conducted to identify confounding variables.

Results Lower socioeconomic status was found to be correlated with increased mortality within 90 postoperative days and throughout the entire follow-up period. Similarly, analysis between the lowest and highest household income quartiles (Q1 vs. Q4) demonstrated Q4 to have significantly decreased mortality during total follow-up and a decreasing but not significant difference in 90-day mortality. No significant difference in morbidity was observed.

Conclusion This study suggests that lower household income is associated with increased mortality in both the 90-day window and total follow-up period. It is possible that there is an opportunity for health care providers to use socioeconomic status to proactively identify high-risk patients and provide additional resources in the postoperative setting.

Keywords

posterior fossa tumor - outcome disparities - socioeconomic status - readmissions


Publication History

Received: 28 February 2020

Accepted: 28 June 2020

Article published online:
12 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008; 372 (9650): 1661-1669
    CrossrefPubMedGoogle Scholar
  • 2 Catalyst N. Social determinants of health (SDOH). NEJM Catal. 2017 Accessed November 16, 2019 at: https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0312
    Google Scholar
  • 3 Curry Jr. WT, Carter BS, Barker II FG. Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988-2004. Neurosurgery 2010; 66 (03) 427-437 , discussion 437–438
    CrossrefPubMedGoogle Scholar
  • 4 Haider AH, Scott VK, Rehman KA. et al. Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors. J Am Coll Surg 2013; 216 (03) 482-92.e12
    CrossrefPubMedGoogle Scholar
  • 5 Bowman K, Telem DA, Hernandez-Rosa J, Stein N, Williams R, Divino CM. Impact of race and socioeconomic status on presentation and management of ventral hernias. Arch Surg 2010; 145 (08) 776-780
    CrossrefPubMedGoogle Scholar
  • 6 Hofmann LJ, Lee S, Waddell B, Davis KG. Effect of race on colon cancer treatment and outcomes in the department of defense healthcare system. Dis Colon Rectum 2010; 53 (01) 9-15
    CrossrefPubMedGoogle Scholar
  • 7 Schoenfeld AJ, Sieg RN, Li G, Bader JO, Belmont Jr. PJ, Bono CM. Outcomes after spine surgery among racial/ethnic minorities: a meta-analysis of the literature. Spine J 2011; 11 (05) 381-388
    CrossrefPubMedGoogle Scholar
  • 8 Lee SL, Shekherdimian S, Chiu VY, Sydorak RM. Perforated appendicitis in children: equal access to care eliminates racial and socioeconomic disparities. J Pediatr Surg 2010; 45 (06) 1203-1207
    CrossrefPubMedGoogle Scholar
  • 9 Meagher AD, Beadles CA, Doorey J, Charles AG. Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury. J Neurosurg 2015; 122 (03) 595-601
    CrossrefPubMedGoogle Scholar
  • 10 Lucas FL, Stukel TA, Morris AM, Siewers AE, Birkmeyer JD. Race and surgical mortality in the United States. Ann Surg 2006; 243 (02) 281-286
    CrossrefPubMedGoogle Scholar
  • 11 Nathan H, Frederick W, Choti MA, Schulick RD, Pawlik TM. Racial disparity in surgical mortality after major hepatectomy. J Am Coll Surg 2008; 207 (03) 312-319
    CrossrefPubMedGoogle Scholar
  • 12 Breslin TM, Morris AM, Gu N. et al. Hospital factors and racial disparities in mortality after surgery for breast and colon cancer. J Clin Oncol 2009; 27 (24) 3945-3950
    CrossrefPubMedGoogle Scholar
  • 13 Hoover EL. There is no scientific rationale for race-based research. J Natl Med Assoc 2007; 99 (06) 690-692
    PubMedGoogle Scholar
  • 14 Kim DH, Daskalakis C, Lee AN. et al. Racial disparity in the relationship between hospital volume and mortality among patients undergoing coronary artery bypass grafting. Ann Surg 2008; 248 (05) 886-892
    CrossrefPubMedGoogle Scholar
  • 15 Lemaire A, Cook C, Tackett S, Mendes DM, Shortell CK. The impact of race and insurance type on the outcome of endovascular abdominal aortic aneurysm (AAA) repair. J Vasc Surg 2008; 47 (06) 1172-1180
    CrossrefPubMedGoogle Scholar
  • 16 Alosh H, Riley III LH, Skolasky RL. Insurance status, geography, race, and ethnicity as predictors of anterior cervical spine surgery rates and in-hospital mortality: an examination of United States trends from 1992 to 2005. Spine 2009; 34 (18) 1956-1962
    CrossrefPubMedGoogle Scholar
  • 17 Kim J, Artinyan A, Mailey B. et al. An interaction of race and ethnicity with socioeconomic status in rectal cancer outcomes. Ann Surg 2011; 253 (04) 647-654
    CrossrefPubMedGoogle Scholar
  • 18 Bennett KM, Scarborough JE, Pappas TN, Kepler TB. Patient socioeconomic status is an independent predictor of operative mortality. Ann Surg 2010; 252 (03) 552-557 , discussion 557–558
    CrossrefPubMedGoogle Scholar
  • 19 Rubinger L, Chan C, Andrade D. et al. Socioeconomic status influences time to surgery and surgical outcome in pediatric epilepsy surgery. Epilepsy Behav 2016; 55: 133-138
    CrossrefPubMedGoogle Scholar
  • 20 Lapar DJ, Bhamidipati CM, Walters DM. et al. Primary payer status affects outcomes for cardiac valve operations. J Am Coll Surg 2011; 212 (05) 759-767
    CrossrefPubMedGoogle Scholar
  • 21 Du XL, Liu C-C. Racial/Ethnic disparities in socioeconomic status, diagnosis, treatment and survival among medicare-insured men and women with head and neck cancer. J Health Care Poor Underserved 2010; 21 (03) 913-930
    CrossrefPubMedGoogle Scholar
  • 22 Manuel JI. Racial/ethnic and gender disparities in health care use and access. Health Serv Res 2018; 53 (03) 1407-1429
    CrossrefPubMedGoogle Scholar
  • 23 Barone AP, Fusco D, Colais P. et al. Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture. Int J Qual Health Care 2009; 21 (06) 379-386
    CrossrefPubMedGoogle Scholar
  • 24 Birkmeyer NJ, Gu N, Baser O, Morris AM, Birkmeyer JD. Socioeconomic status and surgical mortality in the elderly. Med Care 2008; 46 (09) 893-899
    CrossrefPubMedGoogle Scholar
  • 25 Agabiti N, Cesaroni G, Picciotto S. et al; Italian Study Group on Inequalities in Health Care. The association of socioeconomic disadvantage with postoperative complications after major elective cardiovascular surgery. J Epidemiol Community Health 2008; 62 (10) 882-889
    CrossrefPubMedGoogle Scholar
  • 26 Ultee KHJ, Tjeertes EKM, Bastos Gonçalves F. et al. The relation between household income and surgical outcome in the Dutch setting of equal access to and provision of healthcare. PLoS One 2018; 13 (01) e0191464
    CrossrefPubMedGoogle Scholar
  • 27 Glauser G, Dimentberg R, Shultz K, McClintock SD, Malhotra NR. Survival disparity based on household income in 1,970 patients following brain cancer surgery. World Neurosurg 2020; (e-pub ahead of print) DOI: 10.1016/j.wneu.2020.07.016.
    CrossrefPubMedGoogle Scholar
  • 28 Pollom EL, Fujimoto DK, Han SS, Harris JP, Tharin SA, Soltys SG. Newly diagnosed glioblastoma: adverse socioeconomic factors correlate with delay in radiotherapy initiation and worse overall survival. J Radiat Res (Tokyo) 2018; 59 (Suppl. 01) i11-i18
    CrossrefPubMedGoogle Scholar
  • 29 Shin JY, Yoon JK, Diaz AZ. Influence of insurance status and income in anaplastic astrocytoma: an analysis of 4325 patients. J Neurooncol 2017; 132 (01) 89-98
    CrossrefPubMedGoogle Scholar
  • 30 Dubey A, Sung W-S, Shaya M. et al. Complications of posterior cranial fossa surgery--an institutional experience of 500 patients. Surg Neurol 2009; 72 (04) 369-375
    CrossrefPubMedGoogle Scholar
  • 31 U.S. Census Bureau. B19013 median household income in the past 12 months (in 2016 inflation-adjusted dollars): American Community Survey Tables: 2012 -- 2016 (5-Year Estimates) (ACS16_5yr). Accessed July 14, 2020 at: https://www.socialexplorer.com/data/ACS2016_5yr/metadata/?ds=ACS16_5yr&table=B19013H
  • 32 Goodrich JT. History of posterior fossa tumor surgery. In: Özek MM, Cinalli G, Maixner W, Sainte-Rose C. eds. Posterior Fossa Tumors in Children. New York, NY: Springer; 2015: 3-60
    CrossrefGoogle Scholar
  • 33 Cochrane DD, Gustavsson B, Poskitt KP, Steinbok P, Kestle JR. The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood. Pediatr Neurosurg 1994; 20 (01) 19-29
    CrossrefPubMedGoogle Scholar
  • 34 Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) 1993; 12 (01) 162-173
    CrossrefPubMedGoogle Scholar
  • 35 Silow-Carroll S, Edwards JN, Lashbrook A. Reducing hospital readmissions: lessons from top-performing hospitals. Accessed July 14, 2020 at: https://www.commonwealthfund.org/publications/case-study/2011/apr/reducing-hospital-readmissions-lessons-top-performing-hospitals
    Google Scholar
  • 36 Ryan JG, Fedders M, Jennings T, Vittoria I, Yanes M. Clinical outcomes and incremental costs from a medication adherence pilot intervention targeting low-income patients with diabetes at risk of cost-related medication nonadherence. Clin Ther 2014; 36 (12) 1991-2002
    CrossrefPubMedGoogle Scholar
  • 37 Feinberg AT, Hess A, Passaretti M, Coolbaugh S, Lee TH. Prescribing food as a specialty drug. NEJM Catal. 2018 4. (02. Accessed November 18, 2020 at: https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0212
    Google Scholar
  • 38 Turan A, Mascha EJ, Roberman D. et al. Smoking and perioperative outcomes. Anesthesiology 2011; 114 (04) 837-846
    CrossrefPubMedGoogle Scholar
  • 39 Grossman R, Mukherjee D, Chang DC. et al. Preoperative charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients. World Neurosurg 2011; 75 (02) 279-285
    CrossrefPubMedGoogle Scholar
  • 40 Rueth NM, Parsons HM, Habermann EB. et al. Surgical treatment of lung cancer: predicting postoperative morbidity in the elderly population. J Thorac Cardiovasc Surg 2012; 143 (06) 1314-1323
    CrossrefPubMedGoogle Scholar
  • 41 Smits A, Lopes A, Das N. et al. Surgical morbidity and clinical outcomes in ovarian cancer - the role of obesity. BJOG 2016; 123 (02) 300-308
    CrossrefPubMedGoogle Scholar
  • 42 Wilson JR, Tetreault LA, Schroeder G. et al. Impact of elevated body mass index and obesity on long-term surgical outcomes for patients with degenerative cervical myelopathy: analysis of a combined prospective dataset. Spine 2017; 42 (03) 195-201
    CrossrefPubMedGoogle Scholar
  • 43 Chu D, Bakaeen FG, Wang XL, LeMaire SA, Coselli JS, Huh J. Does the duration of surgery affect outcomes in patients undergoing coronary artery bypass grafting?. Am J Surg 2008; 196 (05) 652-656
    CrossrefPubMedGoogle Scholar
  • 44 Kim JY, Khavanin N, Rambachan A. et al. Surgical duration and risk of venous thromboembolism. JAMA Surg 2015; 150 (02) 110-117
    CrossrefPubMedGoogle Scholar
  • 45 Dial BL, Esposito VR, Danilkowicz R. et al. Factors associated with extended length of stay and 90-day readmission rates following ACDF. Global Spine J 2020; 10 (03) 252-260
    CrossrefPubMedGoogle Scholar
  • 46 LaPar DJ, Bhamidipati CM, Harris DA. et al. Gender, race, and socioeconomic status affects outcomes after lung cancer resections in the United States. Ann Thorac Surg 2011; 92 (02) 434-439
    CrossrefPubMedGoogle Scholar
  • 47 Martsolf GR, Barrett ML, Weiss AJ. et al. Impact of race/ethnicity and socioeconomic status on risk-adjusted hospital readmission rates following hip and knee arthroplasty. J Bone Joint Surg Am 2016; 98 (16) 1385-1391
    CrossrefPubMedGoogle Scholar
  • 48 Seicean A, Seicean S, Neuhauser D, Benzel EC, Weil RJ. The influence of race on short-term outcomes after laminectomy and/or fusion spine surgery. Spine 2017; 42 (01) 34-41
    CrossrefPubMedGoogle Scholar