Mortality in Pituitary Adenoma Surgery in Teaching versus Nonteaching Hospitals

Background Pituitary adenomas are among the most common tumors of the central nervous system. Surgical resection is the first-line treatment option for symptomatic pituitary adenomas and for non-prolactinoma functional tumors. Resections are performed at both teaching and nonteaching hospitals across the country. Given differences between the hospitals, with medical education playing a role in teaching hospitals, there is a question of whether or not there is a difference in quality of care for pituitary adenoma resection patients. Outcomes after pituitary adenoma resection between the two types of hospitals have not previously been studied.

Methods A retrospective study was performed of the Nationwide Inpatient Sample, a database of hospital admissions from more than 1,000 hospitals, between the years 2006 and 2011. Teaching and nonteaching hospital admissions for elective pituitary adenoma resection in patients ≥18 years old were included for analysis. Teaching hospitals are defined as those with an AMA-approved residency training program, those with membership in the Council of Teaching Hospitals, or those with a ratio of full-time interns and residents to beds of 1:4 or higher. Analysis between the two types of hospitals included a comparison of patient characteristics, including likelihood of dying and illness severity. The primary outcome explored was inpatient mortality, and the secondary outcome was length of stay.

Results A total of 7,826 admissions from teaching hospitals and 1,618 admissions from nonteaching hospitals were compared. The median age and the proportion of females between the two patient populations had a statistically but not clinically significant difference. The illness severity and likelihood of dying of the patients in teaching hospitals compared with nonteaching hospitals were significantly different (p = 0.004 and p = 0.005, respectively), with more patients in nonteaching hospitals having an “extreme” severity of illness ranking and an “extreme” likelihood of dying ranking. In terms of comorbidities potentially associated with the pituitary adenoma, there were significantly more patients with hypothyroidism in teaching hospitals than in nonteaching hospitals (p = 0.028). No significant difference was seen in hospital deaths between the two groups, while a statistically but not clinically significant difference in length of stay was seen between the two (p < 0.001).

Conclusion No significant difference in inpatient mortality after pituitary adenoma resection was found between teaching and nonteaching hospitals, although there may be a difference between the level of comorbidities of patients undergoing resection in teaching and nonteaching hospitals.

No conflict of interest has been declared by the author(s).