Structural Determinants of Discharge Following Craniotomy for Brain Cancer in New York City: A Cross-Sectional StudyDisparities in post-craniotomy recovery in NYC

Introduction: Craniotomy for malignant brain tumors yields variable recovery. Length of stay (LOS) and discharge disposition (DD) are key measures of recovery, yet the impact of social and structural factors remains unclear. We examined LOS and DD in New York City (NYC) across race, insurance payor status, and borough. Methods: Adults undergoing craniotomy for primary brain malignancy in NYC were queried from the SPARCS database (2018–2022). Disposition – stratified by discharge to home, rehabilitation facility, hospice, nursing facility, or other (also captured leaving against medical advice and in-hospital death) – was assessed under a competing-risks framework with the Fine and Gray method. Predictors included race, payor status, and borough, adjusting for demographics, admission type, year, and illness severity. Results: The cohort included 3,550 discharges with a median LOS of 5 days (interquartile range, IQR: 2, 9). White patients were more likely to be discharged home compared to Black patients. Medicare and Medicaid groups had lower likelihood of home discharge and higher likelihood of institutional discharge, compared to private insurance. Manhattan discharges were more likely to be transitioned to inpatient rehabilitation. Discharges from Bronx or Brooklyn hospitals were more likely to be sent to nursing facilities while hospitals in Staten Island had the highest adjusted risk of in-hospital mortality. Conclusions: Post-craniotomy recovery after malignant brain tumor surgery in NYC may be impacted by social and structural factors including race, payor status, and borough of care. These disparities highlight the need for neurosurgeons to incorporate social risk into preoperative counseling and discharge planning, and for health systems to adopt equity-focused recovery frameworks.