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Transsphenoidal Surgery for Pituitary Tumors in the United States, 1996–2000: Mortality, Morbidity, and the Effects of Hospital and Surgeon Volume

Brain Tumor Center (F.G.B., B.S.), Neuroendocrine Clinical Center (A.K., B.S.), Neurosurgical Service, Departments of Surgery (F.G.B., B.S.) and Medicine (A.K.), Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114

Address all correspondence and requests for reprints to: Brooke Swearingen, M.D., ACC 331 Massachusetts General Hospital Fruit Street, Boston, Massachusetts 02114. E-mail: swearingen{at}helix.mgh.harvard.edu.

Larger surgical caseload is associated with better patient outcome for many complex procedures. We examined the volume-outcome relationship for transsphenoidal pituitary tumor surgery using the Nationwide Inpatient Sample, 1996–2000. Multivariate regression adjusted for patient demographics, acuity measures, medical comorbidities, and endocrine status.

A total of 5497 operations were performed at 538 hospitals by 825 surgeons. Outcome measured at hospital discharge was: death (0.6%), discharge to long-term care (0.9%), to short-term rehabilitation (2.1%), or directly home (96.2%). Outcomes were better after surgery at higher-volume hospitals (OR 0.74 for 5-fold-larger caseload, P = 0.007) or by higher-volume surgeons (OR 0.62, P = 0.02). A total of 5.4% of patients were not discharged directly home from lowest-volume-quartile hospitals, compared with 2.6% at highest-volume-quartile hospitals. In-hospital mortality was lower with higher-volume hospitals (P = 0.03) and surgeons (P = 0.09). Mortality rates were 0.9% at lowest-caseload-quartile hospitals and 0.4% at highest-volume-quartile hospitals. Postoperative complications (26.5% of admissions) were less frequent with higher-volume hospitals (P = 0.03) or surgeons (P = 0.005). Length of stay was shorter with high-volume hospitals (P = 0.02) and surgeons (P < 0.001). Hospital charges were lower for high-volume hospitals, but not significantly.

This analysis suggests that higher-volume hospitals and surgeons provide superior short-term outcomes after transsphenoidal pituitary tumor surgery with shorter lengths of stay and a trend toward lower charges.

Abbreviations: CI, Confidence interval; DI, diabetes insipidus; LOS, length of stay; NIS, Nationwide Inpatient Sample; OR, odds ratio; RBC, red blood cell.

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