Impact of Medicaid Insurance on Outcomes following Endoscopic Transsphenoidal Pituitary Surgery

Introduction: Despite the rise of studies in the neurosurgery literature suggesting that patients with Medicaid insurance have inferior outcomes, there remains a paucity of data on the impact of insurance on outcomes after endonasal endoscopic transsphenoidal surgery (EETS). Given the increasing importance of complications in quality based health care metrics, the objective of this study is to assess whether Medicaid insurance type influences outcomes in EETS for pituitary adenoma.

Methods: The authors analyzed a prospectively acquired database of EETS for pituitary adenoma from 2005 to 2018 at NewYork Presbyterian Hospital, Weill Cornell Medicine. We identified all patients with Medicaid insurance. As a control group, we also reviewed clinical, socioeconomic, and radiographic data of all other patients in the series with all other insurance types. Statistical significance was determined with an α < 0.05 using Pearson’s Chi-square and Fisher’s exact tests for categorical variables and the independent-samples t-test for continuous variables.

Results: Of 584 patients undergoing EETS for pituitary adenoma, 57 (10%) had Medicaid insurance. The median postoperative length of stay was significantly longer for patients with Medicaid insurance compared with the control (4.5 vs. 3 days; p < 0.05). Maximum tumor diameter was significantly larger for Medicaid patients compared with the control (26.1 ± 12 vs. 23.1 ± 11 mm; p < 0.05). Baseline comorbidities were not significantly different between Medicaid cases and the control. Patients with Medicaid insurance had a significantly higher rate of any complication and long-term neurological deficit. The overall complication rate for Medicaid cases was 14% compared with 7% for the control (p < 0.05). The rate of neurologic deficit was 5.3% in Medicaid cases compared with 1.1% of the control (p < 0.05).

Conclusion: The impact of insurance type on EETS for pituitary adenoma has not previously been reported in the literature. We found that larger maximum tumor diameter, longer postoperative length of stay, and higher rate of complications were associated with Medicaid insurance.