title: Racial and socioeconomic disparities in incidence of hospital-acquired complications following cerebrovascular procedures.
abstract: BACKGROUND
  Patients with cerebrovascular disease undergo complex surgical procedures, often requiring prolonged inpatient hospitalization. Previous studies have demonstrated associations between racial/demographic factors and clinical outcomes in patients undergoing cerebrovascular procedures (CVPs). The Centers for Medicare and Medicaid Services have published a series of 11 hospital-acquired conditions (HACs) deemed "reasonably preventable" for which related costs of treatment are not reimbursed. We hypothesize that race and payer status disparities impact HAC frequency in patients undergoing CVPs and that HAC incidence is associated with length of stay and hospital costs.
  
  
  OBJECTIVE
  To assess health disparities in HACs among the cerebrovascular neurosurgical patient population.
  
  
  METHODS
  Data were collected from the Nationwide Inpatient Sample (NIS) database from 2002 to 2010. CVPs and HACs were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedure codes. HAC incidence was evaluated according to demographics including race, payer status, and median zip code income via multivariable analysis. Secondary outcomes of interest included length of stay and resulting inpatient charges.
  
  
  RESULTS
  From 2002 to 2010, there were 1 290 883 CVP discharges with an HAC rate of 0.5%. Significant disparities in HAC frequency existed according to ethnicity and insurance provider. Minorities and Medicaid patients had increased frequency of HACs (P < .05), as well as prolonged length of stay and higher inpatient costs (P < .05).
  
  
  CONCLUSIONS
  HAC incidence is associated with racial and socioeconomic factors in patients who undergo CVPs. Awareness of these disparities may lead to improved processes and protocol implementation, which might help to decrease the frequency of these potentially avoidable events.
authors.affiliation: *Keck School of Medicine, University of Southern California, Los Angeles, California; ‡Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California; §Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wen
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Attenello
authors.forename: Shuhan
authors.initials: S
authors.lastname: He
authors.forename: Yong
authors.initials: Y
authors.lastname: Cen
authors.forename: May A
authors.initials: MA
authors.lastname: Kim-Tenser
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.forename: Arun P
authors.initials: AP
authors.lastname: Amar
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000601:surgery*; D005260:Female; D054624:Health Status Disparities; D017721:Hospital Costs; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology*; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000208:ethnology; D014481:United States