Lack of Insurance May Lead to Increased Mortality After Craniotomy.

Abstract

Socioeconomic status (SES) directly impacts outcomes in health care. Prior studies have demonstrated the impact of insurance type and status on postoperative outcomes in subspecialty populations, including peripheral tumors and the spine. There is a paucity of literature addressing the impact of SES in craniotomy. This study investigates insurance status' impact on outcomes in craniotomy patients. A single-center, retrospective cohort study was conducted on craniotomy patients from 2013-2018. Preoperative demographics, comorbidities, surgical variables, postoperative adverse events, and mortality within 90 days of surgery were collected. Socioeconomic variables include insurance, employment, and disability statuses. Statistical analysis using the Mann-Whitney U test, independent sample t test, and multivariate logistic regression analyses with an alpha of 0.05 were used to compare differences between insured and uninsured patients. A total of 2445 patients who underwent a craniotomy were included in the analysis, with 5.4% being uninsured. An increased prevalence of unemployment was found among uninsured patients (38% vs. 50%, P = 0.007). Uninsured patients were significantly younger (P < 0.001) and had higher prevalence of nonopioid substance use (P = 0.027). Higher adverse event rates were found in uninsured patients. On multivariate analysis, uninsured patients had higher odds of 90-day mortality (OR, 2.393; 95% CI, 1.321-4.334; P = 0.004). Lower SES negatively impacts postoperative outcomes in patients undergoing craniotomy. Uninsured craniotomy patients experienced increased 90-day mortality. Insurance status must be considered in developing comprehensive treatment plans for each patient to minimize the risk of disparate outcomes after a craniotomy.