Comparative Resource Utilization in Patients Undergoing Endoscopic and Microscopic Transsphenoidal Surgery for Pituitary Tumors

Objective: Resource utilization is an increasingly important healthcare metric, particularly in the context of emerging surgical techniques. Despite the widespread adoption of endoscopic transsphenoidal approaches for pituitary lesions, the impact of these approaches on healthcare resource utilization compared with traditional microscopic approaches has not been studied. The purpose of this study was to compare hospital charges in patients with sellar pathology who had undergone either endoscopic or microscopic transsphenoidal surgery to determine the drivers of resource utilization and if there were differences between techniques.

Methods: A complete accounting of all hospital charges for 167 patients prospectively enrolled in a surgical quality of life study at a single pituitary center between October 2011 and June 2013 was undertaken. Patients were assigned to surgical technique group based on surgeon preference and then managed according to a standard postoperative institutional order set. Individual line item charges were assigned to categories (eg, pharmacy, imaging, surgical, laboratory, room, pathology, and recovery unit) to facilitate analysis. Standard univariate and multivariate statistical analyses were conducted to determine the drivers of resource utilization.

Results: Ninety-nine patients underwent microscopic surgery and 68 underwent endoscopic surgery. There were no significant differences between groups in baseline demographic descriptors and tumor characteristics. Mean total hospital charges were $75,714 and $74,216 for microscopic and endoscopic patients, respectively (p = 0.63). Analysis of specific charge type suggested improved radiology resource utilization in the endoscopic group. A two-step multivariate analysis of key variables revealed that length of stay was the most influential variable (accounted for 40% of variance in charges) followed by a diagnosis of Cushing's disease (accounted for a 3% variance in charges).

Conclusions: This study suggests that the adoption of endoscopic transsphenoidal surgery techniques for pituitary lesions does not have an adverse impact on resource utilization during the inpatient epoch. The primary drivers of hospital charges were length of stay and biological factors regardless of surgical technique employed.