Public Insurance Linked to Worse Meningioma Resection Outcomes

Patients with public health insurance who undergo meningioma resection face worse postoperative functional outcomes and longer hospital stays compared with privately insured counterparts, according to findings from a retrospective cohort study published in the Journal of Neuro-Oncology.

Although meningioma is typically a benign intracranial tumor and surgery can be curative, functional recovery after resection can vary widely. Researchers examined whether public insurance, such as Medicare, Medicaid, and Veterans Affairs, compared with private insurance, was associated with differences in surgical and recovery outcomes.

Researchers reviewed records for 795 adults who underwent first-time craniotomy for intracranial meningioma resection between 2011 and 2023. Among them, 315 (39.6%) had public insurance and 480 (60.4%) had private. The public insurance group was older, with a mean age of 65.9 years compared with the private insurance group’s mean age of 49.7 years (P <.001). Women represented 63.8% of the publicly insured group vs 76.3% of the privately insured group (P <.001). Further, a greater proportion of publicly insured patients reported household incomes below the national median (49.8% vs 41.9%; P =.027) and higher rates of diabetes (19.7% vs 10.4%; P <.001). Tumor characteristics also differed, with the public group presenting with larger mean diameters (40.6 mm vs 38.0 mm; P =.010) and a higher proportion of World Health Organization grade II tumors (21.3% vs 12.5%; P =.001).

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Intraoperatively, publicly insured patients were less likely to undergo gross total resection (57.9% vs 66.9%; P =.039). Postoperatively, they experienced worse functional outcomes, with higher mean modified Rankin Scale (mRS) scores (1.5 vs 0.9; P <.001) and lower Karnofsky Performance Status (KPS) scores (83.8 vs 91.0; P <.001). Functional decline from baseline was greater in the public group, reflected by a larger increase in mRS (+0.3 vs 0.0; P <.001) and a greater decrease in KPS (-4.6 vs 0.0; P <.001). These patients also had longer average hospital stays (5.5 vs 4.4 days; P <.001) and higher rates of both neurological (39.0% vs. 28.1%; P =.001) and non-neurological (23.8% vs 14.4%; P <.001) complications.

After adjusting for age, sex, tumor size, comorbidity burden, American Society of Anesthesiologists score, and WHO grade, public insurance remained an independent predictor of worse outcomes. Public insurance was associated with a higher likelihood of subtotal resection compared with gross total resection (odds ratio [OR], 1.74; P =.029), greater postoperative functional decline (mRS, β=0.20; P =.025; KPS, β=−3.74, P =.001), longer length of hospital stay (β=0.83; P =.027), higher postoperative mRS (OR, 1.65; P =.007), and lower postoperative KPS (OR, 0.60; P=.006).

Study limitations include a single-center design, retrospective approach, and the grouping of Medicare and Medicaid patients into a single category.

“These results support the need for systems-level strategies such as enhanced inpatient rehabilitation, structured discharge planning, and early social work involvement to support vulnerable patient populations during the perioperative period,” the study authors concluded.