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Citation
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Bakhsheshian J, Ding L, Tang A, Wen T, Patel A, Strickland BA, Rennert R, Amar A, Gruen P, Giannotta S, Mack W, Attenello F. World Neurosurg. 2018; 119: e284-e293. |
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Affiliation
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Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. |
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Abstract
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BACKGROUND: Clinical outcomes in the surgical management of severe traumatic brain injury (TBI) have been shown to vary across different hospital institutions. The impact of safety-net burden on postoperative mortality, complication rates and failure to rescue (FTR) rates is unclear.
OBJECTIVE: We sought to evaluate the relationship of safety-net burden with outcomes in the management of severe TBI patients undergoing neurosurgery.
METHOD: Hospitals were grouped according to their safety-net burden, defined as the proportion of Medicaid and uninsured patient charges for all hospitalizations during that time. Multivariate analyses were performed to examine significant associations with the degree of safety-net burden while controlling for potential confounders.
RESULTS: Data on 20,989 encounters in 788 hospitals were included. Compared to low-burden hospitals (LBHs), high-burden hospitals (HBHs; OR= 1.48, 95% CI 1.04-2.12, p=0.03) had greater mortality rates. Major complications were more likely to occur at HBHs (OR=1.44, 95% CI 1.12-1.84, p<0.01) when compared to LBHs. The FTR rates were similar amongst all safety-net burden hospital groups. Patients at HBHs also had an increased likelihood for extended length of stay (OR=1.92, 95% CI 1.12-3.29, p= 0.02) and for receiving a tracheostomy or gastrostomy (OR=1.99, 95% CI 1.36-2.89, p<0.01) when compared to patients at LBHs.
CONCLUSIONS: The current study found that greater hospital safety-net burden was independently associated with higher rates of mortality and major complications in the management of severe TBI patients undergoing neurosurgery. Further research in evaluating the cause of disparities in mortality outcomes at high safety-burden hospitals is needed.
Copyright © 2018. Published by Elsevier Inc.
Language: en |