Brain tumor surgery outcomes in rural America: a cross-sectional statewide study
Sophie Epstein1, Zerubabbel K Asfaw1, Tirone Young1
11Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York; and.
Objective:
The aim of this study was to evaluate demographic characteristics and predictors of adverse outcomes among rural New York State (NYS) residents undergoing neurosurgical treatment for brain tumor (BT), with the goal of identifying factors contributing to increased healthcare costs and diminished quality of care.
Methods:
This retrospective cross-sectional study analyzed 2010-2020 discharge data from the New York Statewide Planning and Research Cooperative System (SPARCS). Adults (≥ 18 years) who underwent neurosurgical treatment for BT in NYS hospitals were included, excluding patients residing in New York City. Rural residence was defined by US Department of Justice criteria. Sociodemographic variables included age, race/ethnicity, income quartile, and insurance status. Primary outcomes were postoperative length of stay (LOS), location of discharge (home vs nonhome), emergency department (ED) presentation, and 30-day mortality. Univariate and multivariate mixed-effects regression models identified independent predictors of adverse outcomes.
Results:
Among 25,887 patients, 3745 (14%) resided in rural areas. Despite a significant decline in the NYS rural population during the study period (p < 0.001), rural BT neurosurgical admissions increased (p = 0.005). Rural patients were more often White (91% vs 80%, p = 0.0425) and from lower income quartiles (66% vs 39%, p = 0.0015) than nonrural patients. On multivariable analysis, age > 65 years, male gender, and non-White race predicted ED presentation, whereas private insurance was protective. Nonhome discharge and ED presentation were the strongest predictors of prolonged LOS. ED presentation and older age predicted a nonhome discharge, while private insurance favored home discharge. Thirty-day mortality was independently associated with nonhome discharge, male gender, lower income, and longer LOS. Rural residence was not independently associated with any outcome after adjustment.
Conclusions:
Rural NYS residents undergoing neurosurgical treatment for BT face increasing procedural demand despite a shrinking rural population. Targeted care coordination, improved access pathways, and telemedicine/artificial intelligence-supported interventions may reduce disparities, costs, and adverse outcomes.