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J Neurol Surg B Skull Base 2018; 79(05): 501-507
DOI: 10.1055/s-0038-1635095
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Socioeconomic Factors Affecting Discharge Status of Patients with Uncomplicated Transsphenoidal Adenohypophysectomy

Chelsea S. Hamill
1   Department of Otolaryngology–Head and Neck Surgery, CWRU/University Hospitals, Cleveland Medical Center, Cleveland, Ohio, United States
,
Jennifer A. Villwock
2   Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States
,
Kevin J. Sykes
2   Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States
,
Roukoz B. Chamoun
3   Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
,
D. David Beahm
2   Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States
› Author Affiliations
Further Information

Publication History

14 August 2017

19 January 2018

Publication Date:
26 February 2018 (online)

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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
 

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