TY - JOUR
T1 - Do safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome?
AU - Bhandarkar, Archis R.
AU - Alvi, Mohammed Ali
AU - Naessens, James M.
AU - Bydon, Mohamad
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2021/1
Y1 - 2021/1
N2 - Introduction: Safety-net hospitals provide care to a substantial share of disadvantaged patient populations. Whether disparities exist between safety-net hospitals and their counterparts in performing emergent neurosurgical procedures has not yet been examined. Objective: We used the Nationwide Inpatient Sample (NIS), a national all-payer inpatient healthcare database, to determine whether safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome (CES). Methods: The NIS from 2002 to 2011 was queried for patients with a diagnosis of acute CES who received decompressive surgery. Hospital safety-net burden was designated as low (LBH), medium (MBH), or high (HBH) based on the proportion of inpatient admissions that were billed as Medicaid, self-pay, or charity care. Etiologies of CES were classified as degenerative, neoplastic, trauma, and infectious. Significance was defined at p < 0.01. Results: A total of 5607 admissions were included in this analysis. HBHs were more likely than LBHs to treat patients who were Black, Hispanic, on Medicaid, or had a traumatic CES etiology (p < 0.001). After adjusting for patient, hospital, and clinical factors treatment at an HBH was not associated with greater inpatient adverse events (p = 0.611) or LOS (p = 0.082), but was associated with greater inflation-adjusted admission cost (p = 0.001). Discussion: Emergent decompressive surgery for CES performed at SNHs is associated with greater inpatient costs, but not greater inpatient adverse events or LOS. Differences in workflows at SNHs may be the drivers of these disparities in cost and warrant further investigation.
AB - Introduction: Safety-net hospitals provide care to a substantial share of disadvantaged patient populations. Whether disparities exist between safety-net hospitals and their counterparts in performing emergent neurosurgical procedures has not yet been examined. Objective: We used the Nationwide Inpatient Sample (NIS), a national all-payer inpatient healthcare database, to determine whether safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome (CES). Methods: The NIS from 2002 to 2011 was queried for patients with a diagnosis of acute CES who received decompressive surgery. Hospital safety-net burden was designated as low (LBH), medium (MBH), or high (HBH) based on the proportion of inpatient admissions that were billed as Medicaid, self-pay, or charity care. Etiologies of CES were classified as degenerative, neoplastic, trauma, and infectious. Significance was defined at p < 0.01. Results: A total of 5607 admissions were included in this analysis. HBHs were more likely than LBHs to treat patients who were Black, Hispanic, on Medicaid, or had a traumatic CES etiology (p < 0.001). After adjusting for patient, hospital, and clinical factors treatment at an HBH was not associated with greater inpatient adverse events (p = 0.611) or LOS (p = 0.082), but was associated with greater inflation-adjusted admission cost (p = 0.001). Discussion: Emergent decompressive surgery for CES performed at SNHs is associated with greater inpatient costs, but not greater inpatient adverse events or LOS. Differences in workflows at SNHs may be the drivers of these disparities in cost and warrant further investigation.
KW - Cauda equina
KW - Disparities
KW - Emergent
KW - Safety net
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U2 - 10.1016/j.clineuro.2020.106356
DO - 10.1016/j.clineuro.2020.106356
M3 - Article
C2 - 33203594
AN - SCOPUS:85096170504
SN - 0303-8467
VL - 200
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 106356
ER -