Using a Nationwide Insurance Database to Study Skull Base Tumors

Background: The rarity of skull base pathologies necessitates multicenter data to study them effectively. One method to achieve this is the use of de-identified nationwide insurance databases. A major strength of such databases is the large number of otherwise rare cases that can be identified using diagnosis or procedure codes, which may increase the relevance of findings and aid in statistical analysis.

Aim: We aim to describe our experience using the Optum Clinformatics Data Mart, an anonymized nationwide private insurance database.

Methods: Based on our experience in using this database in studying transsphenoidal resection of pituitary adenomas, with a focus on Cushing’s disease, we describe the benefits and disadvantages of these data, in addition to lessons learned.

Results: Using both diagnosis and procedure codes to identify transsphenoidal resections of pituitary adenomas between the years 2001 and 2019, a total of 7,295 records were found. The quality of available data in this database depended on the documentation and coding in patients' charts, which ultimately shaped the insurance claims. Familiarity with different medical coding systems and their use was necessary for effective querying of these databases. Date-sensitive information, such as date of surgery, was not accurately reflected in the claims and in some cases may affect analysis. Some records were sparse in data, likely reflecting patients with dual insurance plans. Some very relevant medications in risk stratifying patients for skull base surgeries, such as aspirin, are over the counter and were not captured in insurance claims. Analysis of these data required taking these caveats into account, and required modification of the investigation at times in order for analyses to be valid.

Conclusion: Proper planning, expectation setting and analysis is needed when using a nationwide insurance database for skull base research purposes. These challenges illustrate the need for a centralized, nationwide, collaborative skull-base registry.

Publication History

Article published online:
05 February 2024