The impact of gender on long-term outcomes following supratentorial brain tumor resection

Abstract

Purpose

Gender is a known social determinant of health which has been linked disparities in medical care. This study intends to assess the impact of gender on 90-day and long-term morbidity and mortality outcomes following supratentorial brain tumor resection in a coarsened-exact matched population.

Materials and Methods

A total of 1970 consecutive patients at a single, university-wide health system undergoing supratentorial brain tumor resection over a six-year period (09 June 2013 to 26 April 2019) were analyzed retrospectively. Coarsened Exact Matching was employed to match patients on key demographic factors including history of prior surgery, smoking status, median household income, American Society of Anesthesiologists (ASA) grade, and Charlson Comorbidity Index (CCI), amongst others. Primary outcomes assessed included readmission, ED visit, unplanned reoperation, and mortality within 90 days of surgery. Long-term outcomes such as mortality and unplanned return to surgery during the entire follow-up period were also recorded.

Results

Whole-population regression demonstrated significantly increased mortality throughout the entire follow-up period for the male cohort (p = 0.004, OR = 1.32, 95% CI = 1.09 − 1.59); however, no significant difference was found after coarsened exact matching was performed (p = 0.08). In both the whole-population regression and matched-cohort analysis, no significant difference was observed between gender and readmission, ED visit, unplanned reoperation, or mortality in the 90-day post-operative window, in addition to return to surgery after throughout the entire follow-up period.

Conclusion

After controlling for confounding variables, female birth gender did not significantly predict any difference in morbidity and mortality outcomes following supratentorial brain tumor resection. Difference between mortality outcomes in the pre-matched population versus the matched cohort suggests the need to better manage the underlying health conditions of male patients in order to prevent future disparities.

Keywords:

• Brain tumor
• outcomes
• gender
• readmissions
• supratentorial
• social determinants of health

Acknowledgments

The EpiLog Project.

Disclosures statement

The authors have no personal or institutional interest with regards to the authorship and/or publication of this manuscript.

Ethics Committee Approval

This study was approved by the IRB at the University of Pennsylvania. IRB number for this study is: 832794. A waiver of informed consent was granted by the University of Pennsylvania IRB as this study was considered to be minimal risk to patients. All ethical guidelines and rules were followed to protect patient privacy.

Additional information

Funding

This research received no specific grant from any funding agency in the public or commercial or sectors. Support was received from the Kevin and Bernadette McKenna Family Research Fund.