Safety-Net Hospitals Have Increased Costs of Care Following Acoustic Neuroma Surgery

Objective: To evaluate whether safety-net hospital (SNH) status is associated with differences in patient characteristics, postoperative complications, and hospitalization costs following acoustic neuroma resection. Study design: Retrospective analysis of a nationally representative inpatient database. Setting: United States acute care hospitals participating in the Healthcare Cost and Utilization Project National Inpatient Sample (NIS). Patients: Adults (18 y or older) undergoing surgical excision of an acoustic neuroma from 2001 to 2021, identified using ICD-9-CM 04.01 and ICD-10-PCS 00BN0ZZ. Patients with neurofibromatosis type 2 were excluded. Intervention(s): Craniotomy for excision of acoustic neuroma. Main outcome measure(s): Postoperative surgical/CNS and medical complications; total inpatient hospitalization costs. Results: The cohort included 50,991 admissions, of which 13,245 (26.0%) occurred at SNHs. SNH patients were more likely to have Medicaid insurance (8.9% vs. 4.2%) and lower household income. On univariate analysis, SNHs had higher rates of hydrocephalus (6.0% vs. 3.8%), dysphagia (4.3% vs. 2.2%), pulmonary edema (2.1% vs. 1.1%), and sepsis (0.9% vs. 0.2%). After multivariable adjustment, SNH care remained independently associated with increased odds of medical complications (OR: 1.30; 95% CI: 1.01-1.70; P =0.04) but not surgical/CNS complications (OR: 1.10; P =0.23). Mean hospitalization costs were higher in SNHs ($42,749 vs. $36,456; P =0.003), and SNH status independently increased costs by $35,679 per admission ( P =0.02). Conclusions: SNHs care for socioeconomically vulnerable patients undergoing acoustic neuroma resection and experience higher medical complication rates and significantly increased hospitalization costs. These findings highlight the need for resource-informed policy efforts and targeted support to sustain equitable access to complex neurotologic surgery.