Demographic and Socioeconomic Characteristics of Patients Who Undergo Resection of Sinonasal Malignancies with Skull Base Involvement in the United States

Background Sinonasal malignancies with skull base involvement, although rare, carry significant morbidity and mortality. There is a paucity of literature regarding the demographic and socioeconomic profile of these patients and the characteristics of the hospitals in which they are surgically treated. This study utilizes the Nationwide Inpatient Sample (NIS) to offer contemporary analysis of the demographic, socioeconomic, and hospital characteristics of patients in the United States who undergo surgical procedures addressing sinonasal malignancies with skull base involvement.

Methods The 2010 to 2014 NIS was queried for patients with a primary diagnosis of sinonasal malignancy (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 160.0–160.9) who underwent primary surgical procedure in the sinonasal cavity (ICD-9-CM 22.0–22.9) with an associated skull base procedure, either open or endoscopic (ICD-9-CM 01.18, 01.24, 01.31, 01.39, 01.51, 01.53, 02.02, 02.04, 02.06, 02.12, 04.42, 22.63). Descriptive analysis of patient demographics, socioeconomic status, and hospital characteristics was performed.

Results Of the 2,149 patients who underwent resection of a sinonasal malignancy during the study period, 1,037 patients (48.3%) underwent a concurrent skull base procedure. Among these patients with skull base involvement, mean patient age was 61.2 years (standard error of the mean [SEM]: 1.02 years), and the majority of patients were male (62.0%) and white (73.3%). Yearly case volume fluctuated from a nadir of 113 cases in 2011 to a maximum of 300 cases in 2013. Nearly one-third of these patients came from households with the highest quartile for median annual income in their respective zip code (31.9 vs. 19.3% from the lowest quartile for median annual income). Most patients were insured by private carriers (42.6%) or Medicare (41.7%), whereas 10.0% were insured by Medicaid (10.0%) and 1.9% were uninsured. The majority of procedures were performed at urban teaching hospitals (92.2%) and in the geographic South (36.5%). The average length of hospital stay for these patients was 6.0 days (SEM: 0.8 days).

Conclusion Patients who undergo surgical procedures addressing sinonasal malignancies with skull base involvement represent a unique population, trending toward insured, white males with higher economic status. Most patients were insured by private carriers or Medicare. The results of this study suggest potential disparities in access to or utilization of surgical care of sinonasal malignancies with skull base involvement.