Pediatric Pituitary Surgery: Claims-Based Analysis of Practice Patterns and Clinical Outcomes

Objectives: The aim of the study is to investigate variations in practice patterns and clinical outcomes for pediatric pituitary surgery from a national perspective.

Study Design: Retrospective analysis of the Truven Health Analytics MarketScan Research Database.

Subjects and Methods: The MarketScan Research Database in years 2005 to 2016 was queried to identify children <18 years of age who had pituitary surgery. Operative intervention was identified using Current Procedural Terminology (CPT) code 61546 (craniotomy for hypophysectomy or excision or pituitary tumor, intracranial approach), 61548 (hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, no stereotactic), and 62165 (neuroendoscopy, intracranial; with excision of pituitary tumor, trans nasal or transsphenoidal approach) via inpatient and outpatient claims. Pediatric patients were required to be continuously enrolled in a private insurance plan from 3 months prior to definitive surgery to 6 months after discharge from surgery and have an International Classification of Diseases Ninth Revision (ICD-9) or Tenth Revision (ICD-10) diagnosis code of 227.3 (ICD-9) or D35.2 (ICD-10), indicating “benign neoplasm of pituitary gland.” Statistical analysis focused on patient characteristics, procedure type, practice setting, and clinical outcomes.

Results: A total of 268 patients were identified, with a mean age of 15.2 years (median, 16 years; range, 3–18 years) at time of surgery and female predominance (63.1%). Most pediatric pituitary surgeries occurred in the inpatient setting (95.1%). For the time frame examined, pediatric pituitary surgeries occurred with microscopic assistance (59.0%), followed by endoscopic approaches (35.1%), combined endoscopic and microscopic assistance (4.5%) and open (1.5%) techniques. The majority of procedures were performed without the use of intraoperative image guidance (72.8%). The median length of stay was 3 days (interquartile range, 2–5 days), with the vast majority of children (97.9%) discharged to home or self-care.

Conclusion: This nationwide database study is the largest to-date demonstrating practice patterns and clinical outcomes in the area of pediatric pituitary surgery. Pediatric pituitary resection through microscopic and endoscopic approaches in the inpatient setting continues to remain the predominant surgical technique employed in the United States.