Regional Disparities and Evolving Practice Patterns in Surgical Approaches to Pituitary Tumors in the United States

Introduction: Traditional microscopic and endoscopic transsphenoidal approaches are the most common surgical techniques in pituitary surgery. Although there is an increased shift in endoscopic transsphenoidal procedures, the question of optimal surgical technique remains unresolved. Examining regional practice patterns in pituitary surgery can provide valuable insights into which surgical strategies are most accessible, effective, and cost-efficient. The objectives of this analysis are to investigate regional variations in surgical approaches to pituitary tumors and to search for evolving practice patterns in pituitary surgery over the last decade.

Methods: The 2010 Medicare Part B Carrier Summary Database and Medicare Part B National Summary Database from 2003-2010 were examined using pituitary surgery Current Procedure Terminology (CPT) codes 61548 (microscopic transsphenoidal approach), 62165 (endoscopic transsphenoidal approach), and 61546 (transcranial approach). These procedures were examined for temporal and regional variations in surgical preference and cost. Statistical analysis of categorical data was performed using chi-square tests.

Results: Endoscopic transsphenoidal procedures increased by more than 10-fold over the past decade, whereas usage of microscopic transsphenoidal approaches decreased by 23.3%. Nevertheless, the microscopic approach was still the most common transsphenoidal technique overall (64.7%) in 2010 as opposed to the endoscopic approach (35.3%). The microscopic transsphenoidal approach was most predominant regionally in the Southern and Western United States (74% and 69%, respectively). In the Northeast and Midwest, the rates of microscopic and endoscopic transsphenoidal approaches were roughly equivalent. However, the rate of endoscopic transsphenoidal procedures was statistically significantly higher (P < 0.05) in the Northeast and Midwest (47% and 45%, respectively) than in the South and West (26% and 31%, respectively). Transcranial approaches continued to decline from 4% to 2% over the last decade.

Conclusion: Regional disparities in transsphenoidal practice patterns exist in the United States. Although the microscopic approach is still more common overall, there has been an evolving shift toward endoscopic transsphenoidal surgery in the last decade.