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Variations in referral patterns for hypophysectomies among pediatric patients with sellar and parasellar tumors

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Abstract

Purpose

It has been shown that patients admitted to high-volume hospitals for resection of sellar and parasellar lesions experience reduced mortality and morbidity. It remains unknown what preoperative factors influence admission to high-volume centers. We report a nationwide analysis of patients <18 years of age undergoing neurosurgical intervention for these lesions.

Methods

A retrospective analysis of the Nationwide Inpatient Sample was performed with additional factors from the Area Resource File. International Classification of Diseases, 9th Revision diagnosis/procedural codes were used to identify patients undergoing resection of tumors from the pituitary gland or related structures. Patients ≥18 years old were excluded. Covariates included age, gender, race, and insurance status. Multivariate analysis was performed using multiple logistic regression models. A p value <0.05 was considered statistically significant.

Results

In total, 1,063 patients were identified. Most (69.8%) were seen at low-volume centers. Mean (median) patient age was 13.7 (15) years. The majority of patients were female (54.8%), white (61.9%), and insured (90.3%). Hispanics were 44% less likely (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.34–0.92, p < 0.05) to be seen at high-volume centers than their Caucasian counterparts. Each increase in 2-year patient age category was associated with greater access to high-volume centers (OR 1.12, 95% CI 1.03–1.23, p < 0.05), relative to 0–2 years old. Female gender, insurance status, county poverty, neurosurgeon density, and calendar year were not significantly associated with admission to high-volume centers.

Conclusions

Age and racial disparities play a significant role in access neurosurgical care, affecting admission of pediatric patients to high-volume neurosurgical centers across the USA.

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Acknowledgments

This work was supported in part by grants from Johns Hopkins Center for Innovative Medicine, The Children’s Cancer Foundation, and the American Brain Tumor Association.

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The authors do not report any conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Suite 253, Baltimore, MD, 21231, USA

    Debraj Mukherjee, Hasan A. Zaidi, Thomas A. Kosztowski, Aditya Halthore, George I. Jallo & Alfredo Quiñones-Hinojosa

  2. Division of Endocrinology, Johns Hopkins School of Medicine, 1837 East Monument St, Suite 333, Baltimore, MD, 21287, USA

    Roberto Salvatori

  3. Department of Surgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock Suite 688, Baltimore, MD, USA

    David C. Chang

  4. Brain Tumor Stem Cell & Neuro-Oncology Surgical Outcomes Laboratory, Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA

    Alfredo Quiñones-Hinojosa

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  1. Debraj Mukherjee
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  2. Hasan A. Zaidi
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Correspondence to Alfredo Quiñones-Hinojosa.

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Mukherjee, D., Zaidi, H.A., Kosztowski, T.A. et al. Variations in referral patterns for hypophysectomies among pediatric patients with sellar and parasellar tumors. Childs Nerv Syst 26, 305–311 (2010). https://doi.org/10.1007/s00381-009-1014-4

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