title: Racial and gender disparities and the role of primary tumor type on inpatient outcomes following craniotomy for brain metastases.
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.
authors.affiliation: Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.forename: Debraj
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Adam
authors.initials: A
authors.lastname: Elramsisy
authors.forename: Kristin
authors.initials: K
authors.lastname: Nosova
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
authors.forename: John S
authors.initials: JS
authors.lastname: Yu
authors.forename: Keith L
authors.initials: KL
authors.lastname: Black
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D003399:Craniotomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000208:ethnology*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States; D044465:White People / Q000706:statistics & numerical data