title: Insurance status and inequalities in outcomes after neurosurgery.
abstract: OBJECTIVE
  Little is known about socioeconomic differences in postoperative outcomes after neurosurgery. We assessed the relation between insurance status and postoperative complication risk, neurosurgical intensive care unit stay, and hospital stay after neurosurgery.
  
  
  METHODS
  We collected data on 918 consecutive craniotomy or spine-related neurosurgical cases in patients at least 18 years of age at the University of Michigan Hospitals after April 2006. Bivariate χ(2) tests and analysis of variance were used to assess bivariate relations, and multivariable logistic regression models and analysis of covariance were used to adjust for potential confounders.
  
  
  RESULTS
  A total of 11.2% of privately insured patients, 23.6% of Medicare patients, 25.8% of Medicaid patients, and 27.3% of uninsured patients suffered complications within 30 days of surgery (P < 0.001). In adjusted models, odds of postoperative complications among Medicare (odds ratio [OR] = 2.1, 95% confidence interval [CI] 1.3-3.3), Medicaid (OR = 3.1, 95% CI 1.5-6.1), and uninsured patients (OR = 3.6. 95% CI 1.3-10.3) were higher than among privately insured patients. By analysis of covariance, only Medicaid patients had significantly longer intensive care unit (P = 0.040) and hospital stays (P = 0.028) than privately insured patients.
  
  
  CONCLUSIONS
  Our findings suggest important socioeconomic disparities in outcomes after neurosurgical intervention. Access to postoperative outpatient care may mediate our findings.
authors.affiliation: Department of Public Health, Oxford University, Oxford, United Kingdom. ame2145@columbia.edu
authors.forename: Abdulrahman M
authors.initials: AM
authors.lastname: El-Sayed
authors.forename: John E
authors.initials: JE
authors.lastname: Ziewacz
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davis
authors.forename: Darryl
authors.initials: D
authors.lastname: Lau
authors.forename: Hasan K
authors.initials: HK
authors.lastname: Siddiqi
authors.forename: Grettel J
authors.initials: GJ
authors.lastname: Zamora-Berridi
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics* / Q000401:mortality*; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality*; D011787:Quality of Health Care / Q000191:economics / Q000639:trends*; D016896:Treatment Outcome; D014481:United States