Disparities in Post-surgical Length of Stay for Patients with Glioblastoma Multiforme: A Retrospective Cohort Analysis of the NCDB

Introduction: Glioblastoma Multiforme (GBM) is the most common and aggressive CNS neoplasm accounting for roughly half of all malignant primary CNS tumors. Adherence to treatment and employment of surgical resection followed by radiochemotherapy are important predictors of improved long-term GBM outcomes. However, socioeconomic factors have been shown to be associated with disparities in GBM care and outcomes. Here we investigate factors that lead to disparities in post-surgical length of stay (LOS) and survival outcomes for GBM.

Methods: The National Cancer Database (NCDB) was queried from 2010-2019. Adult patients diagnosed with GBM as the primary malignancy were categorized by insurance status. Increased LOS was defined as ≥4 day stay following resection. 32,626 GBM patients were identified, and a multivariate logistic regression analysis was performed using insurance status as the dependent variable.

Results: When adjusted for confounding variables, GBM patients who were uninsured (OR=1.72, 95% CI 1.13-2.64, p=0.012), female (OR=1.22, 95% CI 1.02-1.45, p=0.027), or Black (OR=1.54, 95% CI 1.00-2.37, p=0.049) were significantly more likely to have an increased LOS. Additionally, those treated at facilities with high patient volumes were significantly less likely to have an increased LOS (OR=0.65, 95% CI 0.53-0.80, p< 0.001). Median survival for uninsured patients was 12 months compared to 15 months for those with private insurance (p < 0.001).

Conclusion : Insurance type, demographics, and facility volume are important factors influencing post-surgical length of stay for GBM patients. Insurance alone plays a role in median survival for these patients. Further examination of how socioeconomic disparities may affect short and long-term GBM outcomes should be considered in future analyses.