Uninsured brain cancer patients may be more likely than insured to die after surgery to remove tumor

November 19, 2012

Uninsured patients who undergo surgery to remove a brain tumor could be twice as likely to die in the hospital as those who have the same operation but are privately insured, new Johns Hopkins research suggests. In teaching hospitals, where most neurosurgical procedures take place, those with government-subsidized insurance in the form of Medicaid were found in the same study to have rates of survival closer to those who are privately insured.

"Although the absolute rate of death in both groups is relatively low, the numbers are telling us that there's a disproportionate amount of mortality associated with not having any at all," says Alfredo Quinones-Hinojosa, M.D., a professor of neurosurgery and oncology at the Johns Hopkins University School of Medicine and leader of the study described in the November issue of the . "We have a finding that with no insurance whatsoever have worse outcomes, and we don't have a medical explanation for why that is."

Quinones-Hinojosa emphasized that the uncovered in a review of more than 28,000 were unlikely to be accounted for by a patient's overall state of health, or the ability to access care, factors often cited to explain why the uninsured fare worse. In fact, the researchers found that in patients with no illnesses other than the brain tumor, the uninsured had a threefold higher risk of dying in the hospital compared to privately insured patients.

He says he was surprised to find that patients with state-supported insurance in the form of Medicaid did somewhat better than those with no insurance.

Approximately 612,000 people in the United States have a diagnosis of a primary brain or nervous system tumor. cause roughly 13,000 deaths annually and those diagnosed have a five-year survival rate of about 35 percent.

In their study, Quinones-Hinojosa and his team analyzed data from 28,582 patients between the ages of 18 and 65 who underwent craniotomy (open-skull surgery) for a brain tumor between 1999 and 2008. The data were part of the Nationwide Inpatient Sample (NIS) database. Most of the patients with government insurance were on Medicaid and not Medicare because they were under the age of 65, when Medicare typically kicks in. The researchers found that the uninsured patients were twice as likely to die in the hospital as those who had the same operation but were privately insured.

In general, according to previous research, insurance status may influence health outcomes by affecting a patient's overall health, the ability to access care (meaning they come to a doctor after a disease has become more serious) or the quality of the treatment delivered. Quinones-Hinojosa says the study did not eliminate the possibility that patients who are not able to see a doctor regularly have some medical conditions that are undiagnosed, and therefore are not listed as having other medical conditions in the database that was used. These patients may appear healthy "on paper," but in reality, they could have any number of debilitating and may be more likely to have a worse outcome after surgery.

Another possibility—that caregivers treat differently—is one that needs to be closely looked at, he says.

"This research raises more questions than it answers," he says. "Do we treat these patients differently because they don't have insurance? Are we more eager to withdraw care because the expense of caring for these patients falls on the shoulders of the hospital? I'm hoping that's not the case, but it's something we have to talk about. We need to be aware of these issues and make sure we are making decisions based on sound medical judgment and not some other factor."

Other research has been done and has found that for other critically ill patients, patients without insurance are more likely to die than those with private insurance.

Explore further: Uninsured receive same quantity, value of imaging services as insured in hospital, in-patient setting

More information: Arch Surg. 2012; 147[11]:1017-1024
Critique: Arch Surg. 2012;147[11]:1025

Related Stories

Uninsured receive same quantity, value of imaging services as insured in hospital, in-patient setting

January 6, 2012
Insurance status doesn't affect the quantity (or value) of imaging services received by patients in a hospital, in-patient setting, according to a study in the January issue of the Journal of the American College of Radiology.

Outcomes for cardiac valve procedure patients are affected by insurance status

July 6, 2011
The type of primary insurance patients carry affects outcomes of cardiac valve operations in the United States according to a study in the May issue of the Journal of the American College of Surgeons. As a result, the type ...

Repeated surgeries appear to extend life of patients with deadliest of brain cancers

November 1, 2012
People who undergo repeated surgeries to remove glioblastomas—the most aggressive and deadliest type of brain tumors—may survive longer than those who have just a one-time operation, new Johns Hopkins research suggests.

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.