Socioeconomic Disparities in the Presentation, Management, and Outcomes of Cerebrospinal Fluid Diversion Procedures.

Abstract

We examined the relationship between socioeconomic status (SES) and features of cerebrospinal fluid (CSF) diversion at our academic center in a socially disadvantaged urban setting. We retrospectively analyzed 303 surgeries among 229 patients (0.01-89 years), grouped according to median household income for zip-code (i.e., <$40,000, $40,000-$70,000, $70,000-$100,000, and >$100,000) and insurance type. The median age at surgery was significantly younger for publicly insured patients compared to privately insured patients, despite the 65-year age requirement for Medicare eligibility. Pathology necessitating CSF diversion differed across income quartiles; communicating hydrocephalus was most common in the highest group and congenital hydrocephalus was most common in the lowest income group (P < 0.05). Publicly insured patients were 3.86 times more likely to present with altered mental status than privately insured patients (95% confidence interval [CI]: 1.75-8.49; P < 0.001). Procedure duration and post-operative length-of-stay were longer for publicly than privately insured patients. Despite previously reported associations between SES and surgical outcomes, we did not observe a statistically significant difference in post-operative issues, discharge disposition, or number of procedures per patient across two SES metrics. Physicians should prioritize educating patients about symptoms of elevated intracranial pressure and encourage prompt evaluation when these symptoms arise.