Uninsured patients undergoing a craniotomy procedure for a brain tumor have higher in-hospital postoperative mortality rates than insured patients, according to research published in the November issue of the Archives of Surgery.

Eric N. Momin, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a retrospective cohort study using data from the Nationwide Inpatient Sample involving 28,581 patients, aged 18 to 65 years, who underwent craniotomy procedures for a brain tumor. The association between in-hospital postoperative death and insurance status was examined for the full cohort and for a subset of patients with no comorbidity.

In unadjusted analysis, the researchers found that the mortality rates were 1.3 percent for privately insured patients, 2.6 percent for uninsured patients, and 2.3 percent for Medicare patients. After adjustment for patient characteristics and stratification by hospital for patients without comorbidity, the risk of in-hospital death was still significantly higher among uninsured patients (hazard ratio, 2.62) compared with privately insured patients. After adjustment, the risk of in-hospital mortality was non-significantly higher for Medicare patients (hazard ratio, 2.03; P = 0.06).

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“Uninsured patients undergoing craniotomy for a brain tumor experience worse outcomes than privately insured patients, and this difference is pronounced in teaching hospitals,” the authors write. “This variation in postoperative outcomes remains unexplained by hospital characteristics, including clustering effects, comorbid disease, or socioeconomic variations.”


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