Role of Race, Ethnicity, and Healthcare Coverage in the Presentation and Outcome of Endoscopic Transsphenoidal Surgery in a Diverse Tertiary-Care Pituitary Practice

Introduction: Differences in disease incidence and treatment response among races and ethnicities have been increasingly recognized. Socioeconomic factors also impact presentation, treatment, and outcomes of various diseases. Prior epidemiological studies, for instance, demonstrated a higher incidence of pituitary adenomas in Blacks compared to Whites, and nationwide outcome studies have revealed poorer outcomes among Black and Hispanic patients. The extent to which ethnoracial and socioeconomic disparities in presentation affect surgical treatment and outcome within a single diverse pituitary practice is less well understood.

Objective: To compare disease presentation, perioperative parameters, and surgical outcomes on the basis of race and ethnicity as well as healthcare coverage in patients undergoing transsphenoidal surgery for pituitary adenomas at a single tertiary care facility.

Methods: A retrospective review of all patients who underwent endoscopic transsphenoidal resection of pituitary adenomas was performed. Demographic, presentation, treatment, and follow-up data were reviewed. Analysis was performed using R software. Univariate analyses for continuous variables were conducted using Student’s t-test, and for nominal variables Fisher’s exact test. ANOVA with Tukey’s honest significant difference was used for comparisons among multiple ethnoracial groups. p-Values <0.05 were considered statistically significant.

Results: A total of 290 patients operated on between 2018 and 2022 were included. The average age was 52 years (range: 18–85) and 161 (56%) were female. 121 patients identified as White (42%), 79 Black (27%), 70 Hispanic (24%), and 20 Asian (7%). 64% of patients had nationwide private or commercial insurance and 36% had public healthcare coverage including Medicare and Medicaid, local or no insurance. Black patients were on average 7 years older than Hispanics at the time of surgery (p = 0.029) and were more likely than Whites to have public insurance (p = 0.021). Also compared to White patients, Black patients were less likely to present with functional adenomas (p = 0.0004) but more likely to have suprasellar extension (p = 0.014). Patients with public insurance presented at an older age and with larger tumors (p = 0.00071). Privately insured patients were more likely to present at a younger age and with functional tumors (p = 0.00037). Extent of resection, functional remission, length of stay, intraoperative and postoperative CSF leak, reoperation, and 30-day readmission rates did not differ significantly between patients with different ethnoracial backgrounds or healthcare coverage.

Conclusion: There are significant differences in presentation of surgical pituitary adenomas among patients with different ethnoracial backgrounds or healthcare coverage. However, surgical outcomes and complication rates did not differ significantly between these groups, suggestive of the possibility to overcome presentation disparities within a single tertiary care pituitary practice.

 

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Artikel online veröffentlicht:
05. Februar 2024