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Predictors of access to pituitary tumor resection in the United States, 1988–2005

Brain Tumor Stem Cell and Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II, Room 253, Baltimore, Maryland 21231, USA¹ Division of Endocrinology, Department of Medicine² Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 21231, USA

(Correspondence should be addressed to A Quiñones-Hinojosa; Email: aquinon2{at}jhmi.edu)

Objective: Surgery remains a common form of treatment for sellar and parasellar tumors involving the pituitary gland and adjacent structures. Studies have suggested that pituitary surgery procedures performed at high-volume centers are associated with less adverse outcomes, yet it remains unclear which types of patients are more likely to be admitted to such centers. We set out to determine which factors most influenced admission to these high-volume centers.

Methods: A retrospective analysis of the National Inpatient Sample over an 18-year period was linked to socioeconomic and environmental data contained within the Area Resource File. Only patients undergoing transsphenoidal surgery in the United States, >18-years-old were included. The primary outcome was admission to a high-volume (>25 pituitary surgeries/year) hospital.

Results: Overall, patients' odds of admission to a high-volume center increased over an 18-year time period. However, African–Americans (odds ratio, OR=0.46), Hispanics (OR=0.28), and Asians (OR=0.49) experienced declining odds of admission over time. Patients from high-income brackets (OR=1.53) and from areas with higher neurosurgeon density (OR=1.61) were more likely to be admitted to high-volume centers. Conversely, patients coming from counties with higher poverty (OR=0.92) were less likely to be admitted to high-volume centers.

Conclusion: Racial and socioeconomic factors play a significant role in the admission of patients to high-volume pituitary surgery centers. This study demonstrates potential key policy areas for meaningful intervention to help ease disparities in access to quality care for surgical pituitary disease.