Socioeconomic predictors of case presentations and outcomes in 225 nonfunctional pituitary adenoma resections

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  • 1 School of Medicine, University of California, San Francisco;
  • | 2 School of Medicine, University of California, San Diego;
  • | 3 Department of Radiation Oncology, University of California, San Francisco;
  • | 4 Department of Neurological Surgery, University of California, San Francisco; and
  • | 5 Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California
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OBJECTIVE

Clinical presentations and outcomes of nonfunctional pituitary adenoma (NFPA) resections can vary widely, and very little prior research has analyzed this variance through a socioeconomic lens. This study sought to determine whether socioeconomic status (SES) influences NFPA presentations and postoperative outcomes, as these associations could aid physicians in understanding case prognoses and complications.

METHODS

The authors retrospectively analyzed 225 NFPA resections from 2012 to 2019 at their institution. Race, ethnicity, insurance status, estimated income, and having a primary care provider (PCP) were collected as 5 markers of SES. These markers were correlated with presenting tumor burden, presenting symptoms, surgical outcomes, and long-term clinical outcomes.

RESULTS

All 5 examined SES markers influenced variance in patient presentation or outcome. Insurance status’s effects on patient presentations disappeared when examining only patients with PCPs. Having a PCP was associated with significantly smaller tumor size at diagnosis (effect size = 0.404, p < 0.0001). After surgery, patients with PCPs had shorter postoperative hospital lengths of stay (p = 0.043) and lower rates of readmission within 30 days of discharge (OR 0.256, p = 0.047). Despite continuing follow-up for longer durations (p = 0.0004), patients with PCPs also had lower rates of tumor recurrence (p < 0.0001). Higher estimated income was similarly associated with longer follow-up (p = 0.002) and lower rates of tumor recurrence (p = 0.013). Among patients with PCPs, income was not associated with recurrence.

CONCLUSIONS

This study found that while all 5 variables (race, ethnicity, insurance, PCP status, and estimated income) affected NFPA presentations and outcomes, having a PCP was the single most important of these socioeconomic factors, impacting hospital lengths of stay, readmission rates, follow-up adherence, and tumor recurrence. Having a PCP even protected low-income patients from experiencing increased rates of tumor recurrence. These protective findings suggest that addressing socioeconomic disparities may lead to better NFPA presentations and outcomes.

ABBREVIATIONS

GTR = gross-total resection; NFPA = nonfunctional PA; PA = pituitary adenoma; PCP = primary care provider; SES = socioeconomic status; STR = subtotal resection.

Illustration from Serrato-Avila (pp 1410–1423). Copyright Johns Hopkins University, Art as Applied to Medicine. Published with permission.

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