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
