The influence of facility type on intracranial meningioma treatment and outcomes: predicting overall survival using the National Cancer Database

Nolan J. Brown Department of Neurosurgery, University of California, Irvine, Orange, California;

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Julian Gendreau Johns Hopkins Whiting School of Engineering, Baltimore, Maryland;

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Sachiv Chakravarti Dana-Farber Cancer Institute, Brigham Cancer Center, Boston, Massachusetts;

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Benjamin M. Abraham Jr. College of Osteopathic Medicine, Marian University, Indianapolis, Indiana;
Department of Neurological Surgery, Indiana University, Indianapolis, Indiana

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Yusuf Mehkri Department of Neurosurgery, University of Florida, Gainesville, Florida;

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Cathleen C. Kuo University at Buffalo Jacobs School of Medicine, Buffalo, New York;

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Naib Chowdhury Debusk College of Osteopathic Medicine, Lincoln Memorial University–Harrogate, Tennessee; and

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Aaron Cohen-Gadol Department of Neurological Surgery, Indiana University, Indianapolis, Indiana

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OBJECTIVE

There is a growing body of evidence demonstrating improved outcomes for patients with CNS neoplasms treated at academic centers (ACs) versus nonacademic centers (non-ACs), which represents a potential healthcare disparity within neurosurgery. In this paper, the authors sought to investigate the relationship between facility type and surgical outcomes in meningioma patients.

METHODS

The National Cancer Database was queried for adult patients diagnosed with intracranial meningioma between 2004 and 2019. Patients were stratified by facility type, and the Mann-Whitney U-test and Fisher exact test were used for bivariate comparisons of continuous and categorical variables, respectively. Multivariate logistic regression was used to assess whether demographic variables were associated with treatment at ACs. Furthermore, multivariate Cox proportional hazards models were used to determine whether facility type was associated with overall survival (OS) outcomes.

RESULTS

Data on 139,304 patients (74% male, 84% White) were retrieved. Patients were stratified by facility type, with 50,349 patients (36%) treated at ACs and 88,955 patients (64%) treated at non-ACs. Patients treated at ACs were more likely to have private insurance (41% vs 34%, p < 0.001) and less likely to have Medicare (46% vs 57%, p < 0.001). Patients treated at ACs were more likely to have larger tumors (36.91 mm vs 33.57 mm, p < 0.001) and more likely to undergo surgery (47% vs 34%, p < 0.001). Interestingly, patients treated at ACs had decreased comorbidities (Charlson Comorbidity Index rating 0: 74% vs 69%) and similar income levels (income ≥ $46,000: 44% vs 43%). With respect to survival outcomes, patients treated at ACs demonstrated a higher median OS at 10 years than patients treated at non-ACs (65.2% vs 54.1%). The association of improved OS in patients treated at ACs continued to be true when adjusting for all other clinical and demographic variables (HR 0.900, 95% CI 0.882–0.918; p < 0.001).

CONCLUSIONS

The results of this study indicate that facility type is associated with disparate survival outcomes in the treatment of intracranial meningiomas. Namely, patients treated at non-ACs appear to have a survival disadvantage even when controlling for additional comorbidities.

ABBREVIATIONS

AC = academic center; CCI = Charlson Comorbidity Index; NCDB = National Cancer Database; non-AC = nonacademic center; OS = overall survival.
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Illustration from Martini et al. (pp 386–392). Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.
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