The Association of Neighborhood Level Socioeconomic Status with Discharge and Complications following Transsphenoidal Pituitary Adenoma Resection

Background: Endoscopic transsphenoidal surgery is a popular option for the resection pituitary adenomas. Recent evidence has suggested that socioeconomic disparities exist in outcomes of these operations. However, there exists limited evidence regarding the association between neighborhood level socioeconomic status and outcomes following pituitary adenoma resection utilizing a transsphenoidal approach.

Objective: This article aims to investigate the impact of neighborhood-level socioeconomic status on outcomes following transsphenoidal pituitary adenoma resection.

Methods: We retrospectively reviewed all adult patients at a single institution from 2012 to 2024 who underwent transsphenoidal resection of pituitary adenomas. Patient addresses underwent geospatial analysis and area deprivation index (ADI) was extracted, with patients in the top 15th percentile defined as having high socioeconomic deprivation. Univariable comparison and logistic regressions were utilized to assess the relationship between socioeconomic factors and outcomes.

Results: In total, 767 patients met the inclusion criteria, with 373(49%) being female. The median age at the time of operation was 56 years (interquartile range [IQR]: 44–66). The median ADI of the cohort was 72 (IQR: 52–86). The overall 30-day readmission rate was 10%, and the median length of stay was 2 days (IQR: 2–4). Patients with high ADI were more likely to have prolonged length of stay (>2 days) postoperatively compared to patients with low ADI (47 vs. 37%, p = 0.011). Patients with high ADI were more likely to have postoperative hypopituitarism (14 vs. 7.9%, p = 0.014). Uninsured patients were more likely to be hyponatremic post operatively (59%) compared to privately insured patients (9.8%). Upon logistic regression, postoperative hyponatremia was associated with increased odds of 30-day readmission (odds ratio [OR] 1.98, 95% confidence interval [CI]: 1.08–3.48, p = 0.022). Patients with high ADI (OR: 1.7, 95% CI: 1.04–2.73, p = 0.031) and uninsured patients (OR: 3.55, 95% CI: 1.53–7.76, p = 0.002) had increased odds of postoperative hypopituitarism.

Conclusion: We present the first study reporting the effect of neighborhood-level socioeconomic status on outcomes following transsphenoidal pituitary adenoma resection. Neighborhood-level socioeconomic status is a well validated and highly accurate capture of the patient-level socioeconomic determinants of health. Patients with higher ADI have longer lengths of stay and increased rates of postoperative hyponatremia and hypopituitarism. Neighborhood-level socioeconomic status should be considered in preoperative planning for surgical optimization.

Publication History

Article published online:
07 February 2025