1307 Exploring the Impact of Public Versus Private Insurance Status on Preoperative Presentation in Patients Undergoing Meningioma Resection: A Retrospective Analysis

INTRODUCTION: The impact of patient demographics and socioeconomic factors on healthcare outcomes in neurosurgical oncology is gaining greater recognition. METHODS: A retrospective analysis was conducted on patients undergoing meningioma resection. Insurance status at time of resection, preoperative health status, Modified Rankin Scores (mRS), Karnofsky Performance Scores (KPS), tumor characteristics, and radiographic findings from publicly (Medicare, Medicaid, VA) and privately insured (all private insurer agencies) patients were compared and analyzed. RESULTS: A total of 912 patients were included. The average age was 56.1 years (SD: 14.2), 71.1% were female, and 59.4% were privately insured. There were no significant differences between the insurance groups when considering tumor volume or symptom duration before presentation. When compared to privately insured patients, publicly insured patients had significantly greater preoperative American Society of Anesthesiologists classification (2.63 vs 2.39, p<0.0001) and mRS (1.15 vs 0.88, p<0.0001) scores, and significantly lower preoperative Karnofsky Performance Scores (88.2 vs 91.0, p<0.0001). Those with public insurance also presented with higher WHO grade tumors (1.33 vs 1.18, p<0.0001). Publicly insured patients were more likely to undergo emergent rather than elective resection of the meningioma (8.92% vs 3.52%, p=0.0006). Additionally, those in the publicly insured cohort were more likely to present with edema (45.4% vs 31.2%, p<0.0001) and infarct (2.45% vs 0.74%, p=0.0344) on radiographic imaging. CONCLUSIONS: Compared to those with private insurance, publicly insured patients presented for meningioma resection surgery with poorer health, more severe disability, higher-grade tumors, increased rates of radiographic abnormalities, and were more likely to undergo emergent resections. These disparities suggest the importance of considering insurance status in treatment planning, advocating for more equitable access to timely interventions, and implementing targeted support strategies to optimize outcomes.