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Otology/Neurotology

(272) Insurance Status in Vestibular Schwannoma Surgery: Associations with Post-Operative Outcomes

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • JG

    Jayden R. Garcia, MD

    Resident
    University of Michigan
    Whitmore Lake, Michigan, United States

    • Co-Author(s)

  • KT

    Katherine Tashman, Other

    Harvard Medical School, MA, USA

    • Senior Author(s)

  • James Naples, MD

    Assitant Professor
    Beth Israel Medical Center/ Harvard Medical School
    Needham, Massachusetts, United States

    • Co-Author(s)

  • Sophie E. Yu, BA

    Medical Student
    Harvard Medical School
    Boston, Massachusetts, United States

  • SJ

    Scharukh Jalisi, MD

    Chief, Otolaryngology Head and Neck surgery
    Beth Israel Deaconess Medical Center/ Harvard Medical School
    Boston, Massachusetts, United States

Disclosure(s):
Jayden R. Garcia, MD: No relevant relationships to disclose.
James Naples, MD: No relevant relationships to disclose.
Sophie E. Yu, BA: No relevant relationships to disclose.


Introduction: ​There is a paucity of literature on the social determinants of health in ​vestibular schwannoma (VS) surgery. Our study aims to characterize the association between insurance status and postoperative outcomes in patients with ​VS using a national database.

Methods: The Vizient Database ​was searched for patients who underwent surgical excision for vestibular schwannomas between January 2018 and December 2020 via the D333 ICD 10 code. There were 4913 adult patients ​included in our results. ​The database included information from various hospital settings (e.g., academic, private, for-profit, high-volume, low-volume). Main outcome measures included length of stay (LOS), complications requiring admission, mortality, and direct cost of care. Kruskal-Wallis one-way analysis of variance was used to compare surgical outcomes across insurance groups. Quantile regression was utilized to assess the association between surgical outcomes and insurance groups across the outcome distribution. Multivariable logistic regression was used to find predictors of being in or above the 90th percentile of outcomes.

Results: Public insurance status is associated with a significantly longer length of stay (LOS) (p < 0.001) and direct cost (p=0.041). Patients in the 90th percentile of LOS were more significantly impacted by public insurance status than those in the 50th percentile (β = 5.0, p< 0.001, β = 0.33, p=0.019). This is similarly true for direct cost of care (β = 6836.5, p< 0.001, β = 956.0, p=0.03). The odds of being in or above the 90th percentile of LOS and direct cost are 1.63 (p < 0.001) and 1.51 (p < 0.001) higher with public insurance, respectively.

Conclusions: Public insurance status is associated with increased LOS and direct costs for VS patients. The magnitude of the impact of public insurance increases as LOS and direct costs increase. Public insurance status significantly increases the odds of being in or above the 90th percentile of LOS and direct cost.