Disparities Persist in Pituitary Adenoma Resection at High-Volume Facilities

Access to surgical resection of pituitary adenomas at high-volume facilities (HVFs) is dependent on racial and socioeconomic factors, according to results of a retrospective study published in the Journal of Clinical Endocrinology & Metabolism.

In general, surgical outcomes at HVFs are superior to outcomes at low-volume facilities (LVFs).

To assess the extent of equitable access to HVFs for pituitary adenoma resection in the United States (US), investigators from Johns Hopkins University School of Medicine sourced data from the National Cancer Database (NCDB). Adults (N=57,807) diagnosed with a pituitary adenoma between 2004 and 2019 were evaluated for whether they underwent surgical resection at a HVF on the basis of sociodemographic and clinical characteristics. An HVF was defined as having at least 25 pituitary adenoma resections per year over time.

Among the study population, 52.1% were men, 38.8% were diagnosed before 50 years of age, 63.3% were White, 75.9% had a Charlson-Deyo Index (CDI) of 0, 80.7% lived in a metropolitan area, and 57.4% had private insurance. Most patients (52.4%) underwent surgery at an LVF.

Over time, access to HVFs increased — relative to patients who underwent surgery in 2004, those undergoing surgery in 2019 were more likely to have surgery at an HVF (odds ratio [OR], 1.27).

Women were more likely than men to undergo resection at an HVF (adjusted OR [aOR], 1.07; P <.001), whereas resection at an HVF was less likely among:

• Individuals aged 50 years and older (aOR range, 0.67-0.84; all P <.001);
• Individuals living in a non-urban location (aOR range, 0.79-0.89; both P £.003);
• Non-White individuals (aOR range, 0.80-0.89; all P <.001);
• Individuals who earned at most $63,332 annually (aOR range, 0.82-0.93; all P £.049);
• Individuals on Medicaid vs private insurance (aOR, 0.86; P <.001);
• Individuals living in an area where 6.3% to 17.5% vs less than 6.3% of adults did not complete high school (aOR range, 0.86-0.88; both P <.001); and,
• Individuals with a CDI of at least 2 vs CDI of 0 (aOR, 0.92; P =.045).

When the threshold of the number of surgeries was increased to 50 to qualify as an HVF, trends were similar, except individuals with “Other” race and ethnicity, individuals who lived in a rural location, and individuals with Medicaid insurance were not less likely to undergo surgery at an HVF, and individuals without insurance were less likely to undergo surgery at an HVF than those with private insurance (aOR, 0.54; P <.001).

Study limitations include the fact that the NCDB only covers an estimated 70% of pituitary adenoma cases in the US.

The study authors concluded, “Our analysis utilizing the NCDB, a national cancer dataset, highlights significant racial and socioeconomic disparities in access to high-volume surgical care for adult patients with pituitary adenoma. However, we found indications of narrowing gaps in access to care during the study period.”

This article originally appeared on Endocrinology Advisor