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Invited Critique
Nov 2012

Is Insurance Status a Modifiable Factor in Brain Tumor Treatment Outcomes? Comment on “Postoperative Mortality After Surgery for Brain Tumors by Patient Insurance Status in the United States”

Author Affiliations

Author Affiliations: Department of Neurosurgery, University of Michigan, Ann Arbor.

Arch Surg. 2012;147(11):1025. doi:10.1001/archsurg.2012.1493

Despite advancements in surgical technique and in our understanding of tumor biology, the survival of patients with brain tumors has not vastly improved during the past 2 decades. Exploration of factors that can be changed in individual patients deserves attention. Inequalities in the delivery and implementation of health care in the United States have been well documented. Using the Nationwide Inpatient Sample (NIS), Momin et al1 provide an excellent analysis of uninsured, Medicaid, and privately insured adult patients who underwent craniotomy for a brain tumor. They analyzed International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes collected for 10 years for the surgical treatment of brain tumors from 28 582 patients in 37 states. Their aim was to determine whether insurance status was associated with a higher early in-hospital postoperative mortality rate. They concluded that uninsured (as opposed to Medicaid and privately insured) patients experienced the highest mortality even after exclusion of patients with comorbid illness.

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