The Drivers of Charges in Transsphenoidal Pituitary Surgery: An Analysis of Medical Center Characteristics Across New York State

Background Recent studies have reported increased morbidity in complex pituitary surgeries. Understanding the impact of hospital characteristics on these charges may improve efficient delivery of care. In this study, we analyzed the contribution of hospital characteristics on charges for transsphenoidal pituitary surgery in New York State.

Methods Records of patients who underwent transsphenoidal pituitary surgery between 1995 and 2015 were obtained from the New York State Statewide Planning and Research Cooperative System (SPARCS) database. Patient and hospital characteristics were obtained. Classification of a hospital as a high (76–100th percentile), medium (26–75th percentile), or low volume (0–25th percentile) center was determined by the annual number of procedures. The primary outcome was the total consumer price index (CPI) adjusted hospital charge for the initial visit associated with the surgery. The Kruskal–Wallis test was used to compare continuous variables. Univariate and multivariate linear regression, with adjustment for patient and other hospital features, were used to assess the impact of volume, teaching status, and location on charges.

Results Between 1995 and 2015, a total of 9,950 patients underwent transsphenoidal pituitary surgery. A majority (71.6%) of patients underwent surgery at high volume centers and 2,394 (24.1%) patients received transsphenoidal pituitary surgery at medium volume centers with the remaining 434 (4.4%) undergoing the procedure at low volume centers. The median hospital charges for high, medium, and low centers were $31,534.76, $37,203.31, and $35,636.28, respectively (p < 0.001). Univariate analysis demonstrated that hospitals in New York City were associated with greater charges (+6.9% [3.9–10], p < 0.001). High volume (−12.4% [−20, −5.3], p < 0.001) and teaching hospitals (−24.8% [−34.9, −14.7], p < 0.001) were associated with lesser charges. In the multivariate analysis, the association of charges with teaching status (−15.3% [−22.5, −8.1], p < 0.001) and New York City hospitals (+15% [12.7, 17.4], p < 0.001) persisted. However, after adjustment for patient and other hospital characteristics, medium- (+6.9% [1.7, 12], p = 0.009) and high-volume hospital (+22.5% [17.4, 27.5], p < 0.001) were found to be associated with higher charges.

Conclusion From 1995 to 2015, a majority of patients underwent transsphenoidal pituitary surgery at high-volume hospitals. The teaching status and geographic location of the hospital had a significant impact on charges. While high-volume hospitals had the lowest median charges associated with transsphenoidal pituitary surgery, they were associated with increased charges after adjustment for patient characteristics, suggesting that patient characteristics can greatly affect charges. Although previous studies have shown that higher volume centers tend to have better outcomes, this study shows that this may come at the price of higher charges. Therefore, further detailed studies are needed to determine the drivers of these higher charges at high-volume institutions.

Die Autoren geben an, dass kein Interessenkonflikt besteht.