Trends and Demographic Disparities in the Utilization of Intraoperative Neuromonitoring in the United States, 2008 to 2021

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Abstract
Purpose: Intraoperative neuromonitoring (IONM) is a valuable tool to monitor the neural axis during various procedures and guide intervention aimed at managing operative complications. The literature lacks large scale data on trends and demographic disparities in IONM use in the United States. Methods: Data were abstracted from the 2008–2021 National Inpatient Sample. Hospitalizations for neurosurgical (spinal, craniotomy, carotid artery, cranial/peripheral nerve), cardiac/vascular, and head/neck/thyroid procedures were identified and stratified by IONM use. Logistic regression models were estimated to assess disparities and trends in IONM use. Multivariable models adjusted for patient- and facility-level characteristics. Results: From 2008 to 2021, the rate of IONM use increased significantly in neurosurgical (3.69% to 18.62%, p < 0.001) and cardiac/vascular procedures (0.018% to 0.6%, p < 0.001). IONM use for head/neck/thyroid procedures increased steadily until 2014 and then declined ( p < 0.001). Compared with hospitalizations of White patients, Black (aOR = 0.87, 95% CI: 0.81–0.94) and Hispanic (aOR = 0.88, 95% CI: 0.81–0.96) patients were associated with lower odds of IONM use during craniotomy. Lower incomes (0–25th quartile) were associated with lower odds of IONM use in both spinal (aOR = 0.83, 95% CI: 0.78–0.88) and craniotomy procedures (aOR = 0.78, 95% CI: 0.72–0.85). Conclusions: There is a growing demand for IONM to enhance the safety of various procedures, indicating a need for neurologists and technologists with this expertise. In addition, we found significant racial/ethnic and socioeconomic disparities in IONM use. These findings can be valuable for health care administrators and policymakers to address disparities in the access to IONM.

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