Brain Tumor Res Treat.  2019 Oct;7(2):122-131. 10.14791/btrt.2019.7.e29.

Racial Differences in Hospital Stays among Patients Undergoing Craniotomy for Tumour Resection at a Single Academic Hospital

• Sheppard J
• Lagman C
• Romiyo P
• Nguyen T
• Azzam D
• Alkhalid Y
• Duong C
• Yang I

• KMID: 2461185
• DOI: http://doi.org/10.14791/btrt.2019.7.e29

Abstract

BACKGROUND
Racial differences in American patients undergoing brain tumour surgery remain poorly characterized within urban medical centres. Our objective was to assess racial differences in operative brain tumour patients at a single academic hospital in Los Angeles, California.
METHODS
We reviewed medical records of adult patients undergoing craniotomy for tumour resection from March 2013 to January 2017 at UCLA Medical Centre. Patients were categorized as Asian, Hispanic, Black, or White. Racial cohorts were matched on demographic variables for comparisons. Our primary outcome was post-operative length of stay (LOS). Secondary outcomes included hospital mortality and discharge disposition.
RESULTS
In this study, 462 patients identified as Asian (15.1%), Hispanic (8.7%), Black (3.9%), or White (72.3%). After cohort matching, non-White patients had elevated risk of prolonged LOS [odds ratio (OR)=2.62 (1.44, 4.76)]. No differences were observed in hospital mortality or non-routine discharge. Longer LOS was positively correlated with non-routine discharge [r(pb) (458)=0.41, p<0.001]. Black patients with government insurance had average LOS 2.84 days shorter than Black patients with private insurance (p=0.04). Among Hispanics, government insurance was associated with non-routine discharge [OR=4.93 (1.03, 24.00)].
CONCLUSION
Racial differences manifested as extended LOS for non-White patients, with comparable rates of hospital mortality and non-routine discharge across races. Prolonged LOS loosely reflected complicated clinical course with greater risk of adverse discharge disposition. Private insurance coverage predicted markedly lower risk of non-routine discharge for Hispanic patients, and LOS of three additional days among Black patients. Further research is needed to elucidate the basis of these differences.

Keyword

Brain neoplasms; Craniotomy; Socioeconomic factors; Racial factors

MeSH Terms

Adult
Asian Continental Ancestry Group
Brain
Brain Neoplasms
California
Cohort Studies
Continental Population Groups
Craniotomy*
Hispanic Americans
Hospital Mortality
Humans
Insurance
Insurance Coverage
Length of Stay*
Medical Records
Socioeconomic Factors

Figure

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  Fig. 1 Racial composition of patients undergoing craniotomy for tumor resection. A: All craniotomy patients within our institutional study. B: Craniotomy patients within our study residing in Los Angeles County at time of surgery. C: Racial demographics of Los Angeles County reported in 2010 United States Census.

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  Fig. 2 Relative frequencies of brain tumor pathologies by race in patients undergoing craniotomy for tumor resection at our institution.

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  Fig. 3 Comparisons of average hospital length of stay in patients undergoing craniotomy for tumor resection stratified by (A) patient race, (B) brain tumor pathology, and (C) type of medical insurance. Error bars indicate 95% confidence intervals.

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