Neighborhood socioeconomic status, insurance, and race affect presentation and outcomes following endoscopic pituitary adenoma resection

Abstract

Endoscopic transsphenoidal surgery is a common modality of pituitary adenoma resection. Recent evidence has suggested that socioeconomic disparities exist in outcomes of these operations. However, there exists limited evidence regarding the association between neighborhood socioeconomic disadvantage and outcomes following pituitary adenoma resection utilizing a transsphenoidal approach. We sought to investigate the impact of neighborhood disadvantage on outcomes following transsphenoidal pituitary adenoma resection. We retrospectively reviewed all adult patients at a single institution from 2012 to 2024 who underwent endoscopic transsphenoidal resection of pituitary adenomas. Patient addresses underwent geospatial analysis and Area Deprivation Index (ADI) was extracted, with patients in the top 90th percentile defined as having high socioeconomic deprivation. Univariable comparison and logistic regressions were utilized to assess the relationship between socioeconomic factors and length of stay, readmissions, and endocrine outcomes. In total, 756 patients [median age 56 years (Interquartile range [IQR] 44–66)] met the inclusion criteria. The median ADI of the cohort was 74 (IQR 53–87). Patients who had high neighborhood disadvantage had larger tumor volumes compared to white patients at presentation (5.0 cm 3 vs 3.9 cm 3 , p  = .01). Upon multivariable logistic regression, high neighborhood disadvantage (OR 3.51, 95%CI 1.53–7.98), postoperative hyponatremia (OR 3.87, 95% CI 1.88–8.24), postoperative diabetes insipidus (OR 5.7, 95%CI 2.73–12.4), and being uninsured (OR 4.31, 95%CI 1.05–15.8) were found to be associated with increased odds of prolonged length of stay. Being uninsured was also associated with delayed postoperative hyponatremia (OR 5.38, 95%CI 1.25–19.9), while delayed hyponatremia was associated with increased odds of 30-day readmission (OR 3.35, 95% CI 1.19–8.67). We present the first study reporting the effect of neighborhood-level socioeconomic status on outcomes following transsphenoidal pituitary adenoma resection. Socioeconomic status plays a complex role in surgical outcomes. Further research should focus on underlying drivers of disparities in outcomes in this population.