Predicting the Impact of Race and Socioeconomic Status on Cranioplasty Materials and Outcomes

BACKGROUND: Cranioplasty can be performed with either autologous or synthetic materials. No clear consensus has been reached regarding which material is superior and which social factors might influence the choice of treatment modality and the outcomes. We investigated the effects of race and socioeconomic status on the implant choice and outcomes. METHODS: We conducted a cross-sectional study of adult cranioplasty patients from 2002 to 2017 using the National Inpatient Sample. Autologous implant use, admission costs, length of stay (LOS), and home discharge were analyzed by race, income quartile, and insurance type using multivariable regression models, RESULTS: A total of 105,714 admissions met the liclum sion criteria. Most of the patients were women (50.3%) and White (73.7%). Black, other race, and Medicaid patients had greater odds of autologous graft usage, and patients in the 76th -100th income quartile had lower usage. Higher income patients (51th 75th and 76th 100th) had had significantly higher hospitalization costs, amounting to a $1547.2 increase, compared with the bottom quartile. The Medicaid patients had a longer LOS (odds ratio, 1.06; P = 0.008) and decreased rates of home discharge (odds 0.41; P < 0.001). CONCLUSIONS: We found li creased autologous eranioplasty usage for non-White and Medicaid patients and increased use of higher cost synthetic implants for high income patients. Non -White patients and those from higher income quartiles incurred higher admission costs, Medicaid patients had a longer LOS and decreased rates of home discharge.