The Influence of Facility Type on Intracranial Meningioma Treatment and Outcomes: Predicting Overall Survival Using the National Cancer Database

Introduction: There is a growing body of evidence demonstrating improved outcomes for patients with CNS neoplasms treated at academic centers (ACs) versus nonacademic centers (non-ACs). This represents a potential healthcare disparity within neurosurgery. Herein, we investigate the relationship between facility type and surgical outcomes in meningioma patients.

Methods: The National Cancer Database was queried for adult patients diagnosed with intracranial meningioma between 2004 and 2019. Patients were stratified by facility type and the Mann–Whitney U and Fisher’s exact tests were used for bivariate comparisons of continuous and categorical variables respectively. Multivariable logistic regression was used to assess whether demographic variables predicted treatment at ACs. Furthermore, multivariate cox proportion hazard models were used to determine whether facility type was associated with overall survival (OS) outcomes.

Results: In total, data on 139,304 patients (74% male, 87% white) were retrieved. Patients were stratified by facility type with 50,349 (36%) patients treated at ACs and 88,955 patients (64%) treated at non-ACs. Patients treated at ACs were more likely to have private insurance (41% vs. 34%, p < 0.001) and less likely to have Medicare (46% vs. 57%, p < 0.001). Patients treated at ACs were more likely to have larger tumors (36.91 mm vs. 33.57 mm, p < 0.001) and more likely to undergo surgery (47% vs. 34%, p < 0.001). Interestingly, patients treated at ACs had decreased comorbidities (Charlson Comorbidity Index rating 0: 74% vs. 69%) and similar income (Income $46,000+: 44% vs. 43%). With respect to survival outcomes, patients treated at ACs demonstrated higher median OS at 10-years when compared to patients treated at non-ACs (65.2% vs. 54.1%). The association of improved OS in patients treated at ACs continued to be true when adjusting for all other clinical and demographical variables (HR 0.900, (CI: 0.882-0.918), p < 0.001).

Conclusions: Our results indicate that facility type is associated with disparate survival outcomes in treatment of intracranial meningiomas. Namely, patients treated at non-ACs appear to suffer a survival disadvantage even when controlling for additional comorbidities.

Publication History

Article published online:
05 February 2024