Insurance Status and its Effect on Size at Presentation and Outcomes of Treatment for Benign Spinal Tumors: A National Cancer Database Analysis

Introduction: Benign spinal tumors, especially when asymptomatic, are frequently managed conservatively through observation. However, as tumor size increases and the likelihood of symptom development rises, surgical intervention may be warranted. In the present analysis, we investigated the effect of insurance status on tumor size at presentation and its association with perioperative outcomes.

Methods: The National Cancer Database was queried between 2004-2017 for patients undergoing surgical intervention in the setting of benign spinal tumors. Types of tumors included were schwannomas, meningiomas, neurofibromas, and hemangiomas. Baseline information, including insurance status, was noted. Outcomes of interest consisted of tumor size, length of stay, time from diagnosis to surgery, readmission, and reoperation. Linear and logistic regressions adjusted for baseline factors and tumor type were conducted to identify the effect of insurance status on the outcomes of interest.

Results: A total of 20,132 patients were identified. The mean age of the cohort was 57.2 ±16.7, with 12,192 (60.6%) being female. Most common tumor type was schwannoma (n=10,654; 52.9%), followed by meningioma (n=8016; 39.8%), hemangioma (n=810; 4.0%), and neurofibroma (n=652; 3.2%). In addition, 3.1% of the patients were uninsured, 53.5% had private insurance, 35.3% had Medicare, and 8.2% had Medicaid. Linear regression revealed that private insurance (β=-4.75; p< 0.01), Medicare (β=-5.5; p< 0.01), and Medicaid (β=-5.27; p< 0.01) were associated with a significantly smaller tumor size at presentation, compared to their uninsured counterparts. Similarly, the length of stay was significantly lower for patients with private insurance (β=-1.22; p< 0.01) and Medicare (β=-1.08; p< 0.01), compared to uninsured patients who performed similarly to Medicaid patients (β=-0.21; p=0.58). Time elapsed from diagnosis to surgery was lower for uninsured patients, compared to private insurance (β=4.39; p=0.100), Medicare (β=7.26; p< 0.01), and Medicaid patients (β=6.87; p< 0.01). The rate of readmission was similar among all groups.

Conclusion : In the index study, insurance status exhibited a significant correlation with tumor size, length of stay, and time from diagnosis to surgery. These findings may highlight barriers to timely care for uninsured individuals, who tend to seek medical attention later in the disease course than their insured counterparts, resulting in higher disease burden at presentation and unfavorable outcomes.