Skip to main content

Advertisement

SpringerLink
Log in

Racial and Gender Disparities and the Role of Primary Tumor Type on Inpatient Outcomes Following Craniotomy for Brain Metastases

  • Neuro-Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Race and gender disparities in outcomes have been documented in many cancers. Our study evaluated the role of race, gender, and tumor primary site in predicting in-hospital mortality, discharge disposition, and complications among patients with brain metastases.

Methods

Using Nationwide Inpatient Sample (NIS) data from 1998 to 2007, we evaluated in-patient outcomes of brain metastases patients who underwent a craniotomy in U.S. hospitals. Univariate and multivariate analyses were used to assess the effect of patient/tumor characteristics in predicting the proposed outcomes.

Results

NIS estimated 78,170 patients with metastatic brain tumors underwent craniotomy between 1998 and 2007 in the United States. Median age was 59.2 years, 52.1 % were women, and 6.4 % were black. In-hospital mortality rate was 2.2 % with an average length of stay of 7.6 days. Black patients had significantly higher morbidity and nonroutine discharges than whites/others (p < .0001). Black women had almost twice the mortality (3.4 vs 1.8 %, p < .0001), a higher complication rate (24.6 vs 18.8 %, p < .0001), longer hospital stays (10.0 vs 7.3 days, p < .0001), and more nonroutine discharges (45.1 vs 36.8 %, p < .0001), compared with white/other women. Tumor histology was a significant predictor of outcomes, with female lung cancer patients having the highest odds of mortality and primary gastrointestinal tumors having the highest number of complications.

Conclusions

Evidence of race and gender disparities in outcomes were found in black patients, especially in black females who underwent surgical resection for brain metastases. These findings highlight an opportunity to reduce the gap of outcome disparities in brain metastasis patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Cancer Society 2011. Available from URL http://www.cancer.org/Research/CancerFactsFigures/index [Accessed November, 2011].

  2. Linskey ME, Andrews DW, Asher AL, Burri SH, Kondziolka D, Robinson PD, et al. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:45–68.

    Article  PubMed  Google Scholar 

  3. JS N, A cD, Petersen I JR-C. Metastatic tumors of the CNS. 2000.

  4. Da Silva AN, Nagayama K, Schlesinger DJ, Sheehan JP. Gamma Knife surgery for brain metastases from gastrointestinal cancer. J Neurosurg. 2009;111:423–30.

    Article  PubMed  Google Scholar 

  5. Go PH, Klaassen Z, Meadows MC, Chamberlain RS. Gastrointestinal cancer and brain metastasis: a rare and ominous sign. Cancer. 2011;117:3630–40.

    Article  PubMed  Google Scholar 

  6. Sampson JH, Carter JH, Friedman AH, Seigler HF. Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma. J Neurosurg 1998;88:11–20.

    Article  PubMed  CAS  Google Scholar 

  7. Patchell RA, Regine WF, Loeffler JS, Sawaya R, Andrews DW, Chin LS. Radiosurgery plus whole-brain radiation therapy for brain metastases. JAMA. 2006;296:2089–90; author reply 2090–1.

    Article  PubMed  CAS  Google Scholar 

  8. Ammirati M, Cobbs CS, Linskey ME, Paleologos NA, Ryken TC, Burri SH, et al. The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:85–96.

    Article  PubMed  Google Scholar 

  9. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363:1665–72.

    Article  PubMed  Google Scholar 

  10. Grossman R, Mukherjee D, Chang DC, Purtell M, Lim M, Brem H, et al. Predictors of inpatient death and complications among postoperative elderly patients with metastatic brain tumors. Ann Surg Oncol. 2011;18:521–8.

    Article  PubMed  Google Scholar 

  11. Hofmann MA, Coll SH, Küchler I, Kiecker F, Wurm R, Sterry W, et al. Prognostic factors and impact of treatment in melanoma brain metastases: better prognosis for women? Dermatology. 2007;215:10–6.

    Article  PubMed  Google Scholar 

  12. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43:795–803.

    Article  PubMed  CAS  Google Scholar 

  13. World Health Organization. International Classification of Diseases and Related Health Problems. Geneva, 1993.

  14. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.

    Article  PubMed  CAS  Google Scholar 

  15. Berz JP, Johnston K, Backus B, Doros G, Rose AJ, Pierre S, et al. The influence of black race on treatment and mortality for early-stage breast cancer. Med Care. 2009;47:986–92.

    PubMed  Google Scholar 

  16. Adams SA, Butler WM, Fulton J, Heiney SP, Williams EM, Delage AF et al. Racial disparities in breast cancer mortality in a multiethnic cohort in the Southeast. Cancer. 2011. doi:10.1002/cncr.26570 [Epub ahead of print].

  17. Curry WT, Carter BS, Barker FG. Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988–2004. Neurosurgery 2010;66:427–37; discussion 437–8.

    Article  PubMed  Google Scholar 

  18. Yothers G, Sargent DJ, Wolmark N, Goldberg RM, O’Connell MJ, Benedetti JK, et al. Outcomes among black patients with stage II and III colon cancer receiving chemotherapy: an analysis of ACCENT adjuvant trials. J Natl Cancer Inst. 2011;103:1498–506.

    Article  PubMed  Google Scholar 

  19. Rades D, Hornung D, Veninga T, Schild SE, Gliemroth J. Single brain metastasis: Radiosurgery alone compared with radiosurgery plus up-front whole-brain radiotherapy. Cancer. 2011. doi:10.1002/cncr.26612 [Epub ahead of print].

  20. Clarke JW, Register S, McGregor JM, Grecula JC, Mayr NA, Wang JZ, et al. Stereotactic radiosurgery with or without whole brain radiotherapy for patients with a single radioresistant brain metastasis. Am J Clin Oncol. 2010;33:70–4.

    Article  PubMed  Google Scholar 

  21. Lo SS, Clarke JW, Grecula JC, McGregor JM, Mayr NA, Cavaliere R, et al. Stereotactic radiosurgery alone for patients with 1–4 radioresistant brain metastases. Med Oncol. 2011 28 Suppl 1:S439–44.

    Article  PubMed  Google Scholar 

  22. U.S. Census Bureau. Population Profile of the United States. 2012.

  23. Curry WT, McDermott MW, Carter BS, Barker FG. Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg. 2005;102:977–86.

    Article  PubMed  Google Scholar 

  24. Liu JH, Zingmond DS, McGory ML, SooHoo NF, Ettner SL, Brook RH, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA. 2006;296:1973–80.

    Article  PubMed  CAS  Google Scholar 

  25. Mukherjee D, Zaidi HA, Kosztowski T, Chaichana KL, Salvatori R, Chang DC, et al. Predictors of access to pituitary tumor resection in the United States, 1988–2005. Eur J Endocrinol. 2009;161:259–65.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Miriam Nuño PhD, Debraj Mukherjee MD, MPH, Adam Elramsisy BS, Kristin Nosova MBA, John S. Yu MD, Keith L. Black MD & Chirag G. Patil MD, MS

  2. Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Shivanand P. Lad MD, PhD

  3. Department of Neurosurgery, University of Louisville, Louisville, KY, USA

    Maxwell Boakye MD, MPH

Authors
  1. Miriam Nuño PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Debraj Mukherjee MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adam Elramsisy BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristin Nosova MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shivanand P. Lad MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maxwell Boakye MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John S. Yu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Keith L. Black MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chirag G. Patil MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chirag G. Patil MD, MS.

Additional information

M. Nuño and D. Mukherjee are co-first-authors.

Appendix

Appendix

See Table 6

Table 6 Primary sites (description and codes) for metastatic tumor patients (78,170) who underwent a craniotomy between 1998 and 2007
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nuño, M., Mukherjee, D., Elramsisy, A. et al. Racial and Gender Disparities and the Role of Primary Tumor Type on Inpatient Outcomes Following Craniotomy for Brain Metastases. Ann Surg Oncol 19, 2657–2663 (2012). https://doi.org/10.1245/s10434-012-2353-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2353-z

Keywords

Search

Navigation