Does Having a Primary Care Physician Predict Neurosurgical Outcomes? An Analysis of 225 Nonfunctional Pituitary Adenoma Resections across Seven Years

Objective: Pituitary adenomas are the third most common intracranial tumor. Among these adenomas, the second most common subtype is the nonfunctional pituitary adenoma (NFPA). Clinical presentations and outcomes of NFPA resections can vary widely, with little prior research analyzing this variance through a socioeconomic lens. This study investigated whether having a primary care physician (PCP) is associated with more favorable NFPA presentations and postoperative outcomes.

Methods: A total of 225 NFPA resections from 2012 to 2019 at a single institution were retrospectively analyzed. PCP status was compared to presenting tumor burden and symptoms, surgical outcomes, and long-term clinical outcomes.

Results: Patients with PCPs presented with smaller tumors at the time of initial diagnosis (effect size = 0.404, p < 0.0001). There were no differences observed between surgical outcomes, as rates of complete resection and post-operative complication did not vary. Patients with PCPs had shorter postoperative hospital lengths of stay (p = 0.043), and had lower odds of readmission 30 days after discharge (odds ratio = 0.256, p = 0.047). Patients with PCPs continued follow-up for longer durations (p = 0.0004), and had lower odds of needing future pituitary surgeries (odds ratio = 0.111, p < 0.0001).

Conclusions: This study found that not having a PCP was associated with increased presenting tumor burden, and significantly impacted hospital lengths of stay, readmission rates, follow-up adherence, and odds of needing a future pituitary reoperation. These striking disparities may directly influence postoperative planning, where neurosurgical teams are in a unique position to counsel patients. Our findings underscore the importance of adequate coverage for NFPA patients, and demonstrate its impact on surgical outcomes.

Table 1 Demographics, clinical characteristics, and outcomes, according to PCP status (n = 225)^a

Variable	No PCP	PCP	Effect size	p-Value
Sex—M	14	106	n/a	0.861
Sex—F	14	91	n/a	0.861
Age	48.93 ± 16.56	58.87 ± 13.81	n/a	<0.0001
Tumor axis length—cm	2.40 ± 1.26	2.06 ± 0.79	0.404	<0.0001
Length of stay—daysb	2.50 ± 3.16	2.00 ± 3.11	0.135	0.043
Follow-up time—months	22.36 ± 17.07	37.59 ± 21.94	0.234	0.0004

Table 2 Binary clinical characteristics and outcomes, according to PCP status (n = 225)

Variable	No PCP	PCP	Odds ratio (95% CI)	p-Value
Gross total resection	13/28 (46.4%)	116/197 (58.9%)	1.54 (0.689–3.455)	0.395
Postoperative infection	1/28 (3.6%)	5/197 (2.5%)	0.704 (0.075–34.473)	0.554
Postoperative diabetes insipidus	5/28 (17.9%)	17/197 (8.6%)	0.434 (0.146–1.289)	0.231
30-day readmissions	4/28 (14.3%)	8/197 (4.1%)	0.256 (0.063–1.251)	0.047
Future reoperation	7/28 (25.0%)	7/197 (3.6%)	0.111 (0.035–0.346)	<0.0001

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

Publication History

Article published online:
12 February 2021