Social determinants of health predict 90-day mortality among brain tumor patients

From the 2022 HVPA National Conference

Adrian Jimenez B.S. (Johns Hopkins University School of Medicine), Kyle Cicalese B.S., B.A., Sachiv Chakravarti, Jose Porras M.D., Tej Azad M.D., M.S., Christopher Jackson M.D., Gary Gallia M.D., Ph.D., Chetan Bettegowda M.D., Ph.D., Jon Weingart M.D., Debraj Mukherjee M.D., M.P.H.

Background

Within the neurosurgical oncology literature, the effect of structural and socioeconomic factors on postoperative outcomes remains unclear.

Objective

This study quantified the effects of social determinants of health disparities (SDOH) on hospital postoperative complications, length of stay (LOS), nonroutine discharge, 90-day readmission, and 90-day mortality following brain tumor surgery.

Methods

We retrospectively reviewed brain tumor patients who underwent surgical resection at a single institution (2017-2019). The prevalence of SDOH among patients was tracked using ICD-9/ICD-10 codes. Bivariate (Mann-Whitney U and Fisher’s exact tests) and multivariate (logistic and linear) regressions assessed whether there was an independent relationship between SDOHs and postoperative outcomes.

Results

Our patient cohort included 2,519 patients (mean age 55.27 15.14 years), 187 (7.4%) of whom experienced at least one SDOH. Patients who experienced a SDOH were significantly more likely to be female (odds ratio [OR]=1.36, p=0.048), Black (OR=1.91, p<0.001), and unmarried (OR=1.55, p=0.0049). Patients who experienced SDOHs also had significantly higher mFI-5 (p<0.001) and ASA scores (p=0.0012).

Experiencing a SDOH was associated with significantly longer LOS (p=0.0036), greater odds of nonroutine discharge (OR=1.64, p=0.0092), and greater odds of 90-day mortality (OR=0.35 p=0.0016) in bivariate analysis. When controlling for patient demographics, tumor diagnosis, mFI-5, ASA score, and surgery number, SDOHs independently predicted hospital LOS (coefficient=1.22, p=0.016) and increased odds of 90-day mortality (OR=2.12, p=0.028).

Conclusion

SDOHs independently predict hospital length of stay and 90-day mortality in brain tumor patients.

Clinical Implications

Working to address these disparities offers a new avenue through which to reduce patient morbidity and mortality following brain tumor surgery.

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