Journal of Neuro-Oncology

, Volume 115, Issue 2, pp 277–283 | Cite as

Institutional charges and disparities in outpatient brain biopsies in four US States: The State Ambulatory Database (SASD)

  • Kimon Bekelis
  • Symeon Missios
  • David W. Roberts
Clinical Study


Several groups have demonstrated the safety of ambulatory brain biopsies, with no patients experiencing complications related to early discharge. Although they appear to be safe, the reasons factoring into the selection of patients have not been investigated. We performed a cross-sectional study involving 504 patients who underwent outpatient and 10,328 patients who underwent inpatient brain biopsies and were registered in State Ambulatory Surgery Databases and State Inpatient Databases respectively for four US States (New York, California, Florida, North Carolina). In a multivariate analysis private insurance (OR 2.45, 95 % CI, 1.85, 3.24), was significantly associated with outpatient procedures. Higher Charlson Comorbidity Index (OR 0.16, 95 % CI, 0.08, 0.32), high income (OR 0.37, 95 % CI, 0.26, 0.53), and high volume hospitals (OR 0.30, 95 % CI, 0.23, 0.39) were associated with a decreased chance of outpatient procedures. No sex, or racial disparities were observed. Institutional charges were significantly less for outpatient brain biopsies. There was no difference in the rate of 30-day postoperative readmissions among inpatient and outpatient procedures. The median charge for inpatient surgery was $51,316 as compared to $12,266 for the outpatient setting (P < 0.0001, Student’s t test). Access to ambulatory brain biopsies appears to be more common for patients with private insurance and less comorbidities, in the setting of lower volume hospitals. Further investigation is needed in the direction of mapping these disparities in resource utilization.


Brain biopsy Ambulatory Socioeconomic disparities SID SASD 



We would like to thank Mr. Vasilios Georgitsis for his technical advice and expertise in troubleshooting some of the statistical software. We would also like to thank Brook Martin, Ph.D. for providing the databases for analysis.



Conflict of interest


Supplementary material

11060_2013_1227_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 36 kb)


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kimon Bekelis
    • 1
  • Symeon Missios
    • 2
  • David W. Roberts
    • 1
    • 3
    • 4
  1. 1.Section of NeurosurgeryDartmouth-Hitchcock Medical Center, One Medical Center Dr.LebanonUSA
  2. 2.Coastal NH Neurosurgeons, Portsmouth HospitalPortsmouthUSA
  3. 3.Geisel School of Medicine at DartmouthHanoverUSA
  4. 4.Department of NeurologyDartmouth-Hitchcock Medical CenterLebanonUSA

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