Do safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome?

•Safety-net hospitals had greater inpatient costs in performing emergent decompression for cauda equina syndrome.•Safety-net hospitals did not have greater LOS in performing emergent decompression.•Safety-net hospitals did not have greater rates of inpatient adverse events in performing emergent decompression. Safety-net hospitals provide care to a substantial share of disadvantaged patient populations. Whether disparities exist between safety-net hospitals and their counterparts in performing emergent neurosurgical procedures has not yet been examined. We used the Nationwide Inpatient Sample (NIS), a national all-payer inpatient healthcare database, to determine whether safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome (CES). The NIS from 2002 to 2011 was queried for patients with a diagnosis of acute CES who received decompressive surgery. Hospital safety-net burden was designated as low (LBH), medium (MBH), or high (HBH) based on the proportion of inpatient admissions that were billed as Medicaid, self-pay, or charity care. Etiologies of CES were classified as degenerative, neoplastic, trauma, and infectious. Significance was defined at p