Socioeconomic Factors Affecting Discharge Status of Patients with Uncomplicated Transsphenoidal Adenohypophysectomy

Abstract

Objectives The number of transsphenoidal adenohypophysectomies (TSAs) surgeries has grown significantly since 1993. While there has been an overall decreasing trend in length of stay (LOS), socioeconomic factors may impact hospitalization. This study explores the impact of socioeconomic factors on LOS and total charges in uncomplicated patients undergoing TSA.

Design Retrospective cohort.

Setting 2009 to 2013 Nationwide Inpatient Sample.

Participants Patients undergoing TSA without medical complications.

Main Outcomes Measures LOS and total charges.

Results A total of 6,457 patients were identified, of which 17.2% had secreting tumors. Patients with secreting tumors stayed 2.95 days versus those with nonsecreting tumors stayed 3.26 days (p < 0.001). Discharge to other than self-care was the largest contributing variable for both subsets, increasing both LOS and total charges. Patient factors that drove longer LOS and increased total charges for both subsets included metropolitan domicile, having a lower median income, Hispanic ethnicity, and having an increased amount of Agency for Healthcare Research and Quality (AHRQ) comorbidity indices. Having private insurance predicted a shorter LOS and lower total charges.

Conclusions These results demonstrate that, even without complications, patients can be delayed in their discharge. While several socioeconomic factors significantly predict LOS and charges, the discharge disposition ultimately has the greatest effect. This suggests that efforts should focus on improving organizational factors such as coordination with social work and outside facilities to decrease LOS and charges for this patient population.

Keywords

pituitary tumor - transsphenoidal adenohypophysectomy - socioeconomic factors - discharge disposition - hospital length of stay - hospital total charges

• References

• 1 Villwock JA, Villwock M, Deshaies E, Goyal P. Significant increases of pituitary tumors and resections from 1993 to 2011. Int Forum Allergy Rhinol 2014; 4 (09) 767-770
• 2 Pearson SD, Kleefield SF, Soukop JR, Cook EF, Lee TH. Critical pathways intervention to reduce length of hospital stay. Am J Med 2001; 110 (03) 175-180
• 3 Thomas JG, Gadgil N, Samson SL, Takashima M, Yoshor D. Prospective trial of a short hospital stay protocol after endoscopic endonasal pituitary adenoma surgery. World Neurosurg 2014; 81 (3-4): 576-583
• 4 Barker II FG, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 2003; 88 (10) 4709-4719
• 5 Cavallo LM, Solari D, Esposito F, Cappabianca P. Endoscopic endonasal approach for pituitary adenomas. Acta Neurochir (Wien) 2012; 154 (12) 2251-2256
• 6 DeKlotz TR, Chia SH, Lu W, Makambi KH, Aulisi E, Deeb Z. Meta-analysis of endoscopic versus sublabial pituitary surgery. Laryngoscope 2012; 122 (03) 511-518
• 7 Grossman R, Mukherjee D, Chaichana KL. , et al. Complications and death among elderly patients undergoing pituitary tumour surgery. Clin Endocrinol (Oxf) 2010; 73 (03) 361-368
• 8 Leach P, Abou-Zeid AH, Kearney T, Davis J, Trainer PJ, Gnanalingham KK. Endoscopic transsphenoidal pituitary surgery: evidence of an operative learning curve. Neurosurgery 2010; 67 (05) 1205-1212
• 9 Rotenberg B, Tam S, Ryu WH, Duggal N. Microscopic versus endoscopic pituitary surgery: a systematic review. Laryngoscope 2010; 120 (07) 1292-1297
• 10 Wilson D, Jin DL, Wen T. , et al. Demographic factors, outcomes, and patient access to transsphenoidal surgery for Cushing's disease: analysis of the Nationwide Inpatient Sample from 2002 to 2010. Neurosurg Focus 2015; 38 (02) E2
• 11 Goljo E, Parasher AK, Iloreta AM, Shrivastava R, Govindaraj S. Racial, ethnic, and socioeconomic disparities in pituitary surgery outcomes. Laryngoscope 2016; 126 (04) 808-814
• 12 Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47 (11) 1245-1251
• 13 Cleves MA, Sanchez N, Draheim M. Evaluation of two competing methods for calculating Charlson's comorbidity index when analyzing short-term mortality using administrative data. J Clin Epidemiol 1997; 50 (08) 903-908
• 14 Ghali WA, Hall RE, Rosen AK, Ash AS, Moskowitz MA. Searching for an improved clinical comorbidity index for use with ICD-9-CM administrative data. J Clin Epidemiol 1996; 49 (03) 273-278
• 15 Inder WJ, Hunt PJ. Glucocorticoid replacement in pituitary surgery: guidelines for perioperative assessment and management. J Clin Endocrinol Metab 2002; 87 (06) 2745-2750
• 16 Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol (Oxf) 1999; 50 (04) 431-439
• 17 Kabil MS, Eby JB, Shahinian HK. Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg 2005; 48 (06) 348-354
• 18 Bur AM, Brant JA, Newman JG. , et al. Incidence and risk factors for prolonged hospitalization and readmission after transsphenoidal pituitary surgery. Otolaryngol Head Neck Surg 2016; 155 (04) 688-694
• 19 Sarkiss CA, Lee J, Papin JA. , et al. Pilot study on early postoperative discharge in pituitary adenoma patients: effect of socioeconomic factors and benefit of specialized pituitary centers. J Neurol Surg B Skull Base 2015; 76 (04) 323-330
• 20 Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry 2014; 29 (02) 160-168
• 21 Huang DJ, Xie LZ, Qiu Y. Analysis of factors affecting the length of hospital stay for patients with diabetes. Exp Clin Endocrinol Diabetes 2016; 124 (01) 5-10
• 22 Liu Y, Phillips M, Codde J. Factors influencing patients' length of stay. Aust Health Rev 2001; 24 (02) 63-70
• 23 Wright SP, Verouhis D, Gamble G, Swedberg K, Sharpe N, Doughty RN. Factors influencing the length of hospital stay of patients with heart failure. Eur J Heart Fail 2003; 5 (02) 201-209
• 24 Agboado G, Peters J, Donkin L. Factors influencing the length of hospital stay among patients resident in Blackpool admitted with COPD: a cross-sectional study. BMJ Open 2012; 2 (05) 2
• 25 Amrtia AB. Factors affecting the average length of stay of the patients in the inpatient department in a tertiary care center in north India. Journal of Evolution of Medical and Dental Sciences. 2015; 4 (02) 150-155
• 26 Baumann M, Evans S, Perkins M. , et al. Organisation and features of hospital, intermediate care and social services in English sites with low rates of delayed discharge. Health Soc Care Community 2007; 15 (04) 295-305
• 27 Glasby J, Littlechild R, Pryce K. Show me the way to go home: a narrative review of the literature on delayed hospital discharges and older people. Br J Soc Work 2004; 34: 1189-1197
• 28 Mainous III AGI, Diaz VA, Everett CJ, Knoll ME. Impact of insurance and hospital ownership on hospital length of stay among patients with ambulatory care-sensitive conditions. Ann Fam Med 2011; 9 (06) 489-495
• 29 Comino EJ, Harris MF, Islam MD. , et al. Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study. BMC Health Serv Res 2015; 15: 12
• 30 Cooper RA, Cooper MA, McGinley EL, Fan X, Rosenthal JT. Poverty, wealth, and health care utilization: a geographic assessment. J Urban Health 2012; 89 (05) 828-847