Racial and Ethnic Disparities in Outcomes and Costs in Pituitary Surgery Patients

Objective: To investigate the influence of race and ethnicity on complication rates, cost, and length of stay in patients undergoing pituitary surgery.

Study Design: Retrospective cross-sectional study of the 2008–2012 Nationwide/National Inpatient Sample.

Methods: Patient demographics, hospital characteristics, and post-operative complications for patients undergoing pituitary surgery were compared between white, black, and Hispanic patients. Complication rates between groups were further analyzed via logistic regression analysis. Variables associated with increased cost and increased length of hospital stay were ascertained and compared against each racial and ethnic group via multiple linear regression analysis.

Results: A total of 8,812 patients met the inclusion criteria. 5,924 (67.2%) patients were white, 1,590 (18.0%) were black, and 1,296 (14.7%) were Hispanic. Patient variables found to be significantly different between groups via univariate analysis were age, number of chronic conditions, gender, income, and primary payer. Hospital variables found to be significantly different were location/teaching status, region, and ownership. Differences in complication rates were seen for bacterial meningitis, diabetes insipidus, iatrogenic pituitary disorders, fluid and electrolyte disorders, pulmonary complications, and renal/urinary complications. Logistic regression analysis found fluid and electrolyte disorders and renal/urinary disorders to be significantly more common in blacks compares to whites (OR 1.45, 95% CI 1.23–1.72; OR 2.23, 95% CI 1.45–3.44, respectively) and iatrogenic pituitary disorders to be significantly more common in blacks compared with Hispanics (OR 2.51, 95% CI 1.10–5.74). Hospitalization cost was significantly lower for whites (-$3,082, 95% CI -$3,961 to -$2,202) and significantly higher for both blacks ($1,889, 95% CI $842 - $2,937) and Hispanics ($2,997, 95% CI $1,842 to $4,152). Length of hospital stay was likewise significantly lower in whites (-1.01, 95% CI -1.31 to -0.72) and significantly higher for both blacks (0.65, 95% CI 0.30 to 1.00) and Hispanics (0.96, 95% CI 0.57 to 1.35).

Conclusion: Racial and ethnic disparities in outcomes and hospital utilization exist for patients undergoing pituitary surgery. The variables assessed in this study explained some, but not all factors contributing to these differences. Further investigations are necessary to uncover the sources of these disparities in an effort to provide safer and more affordable care to all patients.