Disparities in meningioma resection outcomes: a retrospective analysis of patients with public versus private insurance.

PURPOSE: Meningiomas are the most common primary brain tumor in the United States. However, the influence of socioeconomic factors—particularly insurance status—on surgical outcomes remains unclear. This study assesses whether insurance status (private vs. public) impacts intraoperative and postoperative outcomes in patients undergoing meningioma resection. METHODS: We performed a retrospective analysis of patients who underwent craniotomy for meningioma resection at a single academic center between 2011 and 2023. Patients were grouped by insurance type (public vs. private). Univariable and multivariable logistic, ordinal, and linear regression models were used to adjust for confounders, including age, sex, tumor diameter, ASA score, number of comorbidities, and WHO grade. RESULTS: A total of 795 patients were included, with 315 (40%) publicly insured and 480 (60%) privately insured. The average age was 56 years (SD: 14.2), and 71% were female. Public insurance was associated with higher postoperative modified Rankin Scores (mRS) (OR = 1.65, p = 0.007) and lower postoperative Karnofsky Performance Scores (KPS) (OR = 0.60, p = 0.006). It also predicted greater increases in mRS (β = 0.20, p = 0.025) and greater declines in KPS (β = -3.74, p = 0.001) postoperatively. These patients also had longer mean hospital stays (β = 0.82, p = 0.031). CONCLUSION: Publicly insured patients undergoing meningioma resection experienced worse functional outcomes and longer hospitalizations. These findings underscore the role of insurance status in surgical recovery and highlight the need for targeted interventions—such as enhanced follow-up and improved access to rehabilitation—to address disparities and support recovery in this vulnerable population.