Hospital Charge Variability across New York State: Sociodemographic Factors in Pituitary Surgery
22 July 2018
13 November 2018
04 January 2019 (online)
Introduction Significant charge disparities exist across New York State (NYS). Race and income are associated with increased charges. To determine risk factor, we correlate hospital charges for pituitary surgery with socioeconomic factors. Additionally, we identify patients at risk for increased hospital charges and provide insight into cost-effective practices.
Methods Retrospective cohort study of the Statewide Planning and Research Cooperative System (SPARCS) database from the NYS Department of Health was conducted. The SPARCS database was reviewed. Patients who underwent transsphenoidal pituitary surgery from 1995 to 2015 were identified. Income and urban status were referenced from U.S. census data. Linear regression was performed to analyze the effect of sociodemographic factors, comorbidities, and complications on hospital charges while controlling for length of stay.
Results A total of 9,373 patients were identified. Black (10.8%, p < 0.001) and Asian (14.5%, p < 0.001) had higher hospital charges. Patients from nonurban cities (13.4%, p < 0.001), Medicaid (13.8%, p < 0.001), and those from the 0 to 25th (9.1%, p < 0.001) and 25 to 50th (11.7%, p < 0.001) income quartile had lower hospital charges. Patients with postoperative cerebrospinal fluid leak (24.0%, p < 0.001), diabetes insipidus (22.1%, p < 0.001), smoking history (11.8%, p < 0.001), hypertension (7.4%, p < 0.001), and hypothyroidism (6.9%, p < 0.001) had higher hospital charges.
Conclusion Patients incurring higher chargers were more likely to have a smoking history, hypertension, hypothyroidism, and comorbidities. The determinants of this analysis may provide insight into barriers to patient access and cost improvement strategies. In addition, this emphasizes the need for future studies to create a risk stratification model, similar to those in other fields.
Podium presentation at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A.
- 1 Melmed S, Kleinberg D. Pituitary masses and tumors. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. , eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia: Elsevier; 2017: 232-299
- 2 Asemota AO, Ishii M, Brem H, Gallia GL. Comparison of complications, trends, and costs in endoscopic vs microscopic pituitary surgery: analysis from a US health claims database. Neurosurgery 2017; 81 (03) 458-472
- 3 Ament JD, Yang Z, Khatchadourian V, Strong EB, Shahlaie K. Cost-effectiveness of endoscopic versus microscopic transsphenoidal surgery for pituitary adenoma. World Neurosurg 2018; 110: e496-e503
- 4 Karsy M, Brock AA, Guan J, Bisson EF, Couldwell WT. Assessment of cost-drivers in transsphenoidal approaches for resection of pituitary tumors using the value-drive outcome database. World Neurosurg 2017; 105: 818-823
- 5 Newhouse JP, Garber AM. Geographic variation in health care spending in the United States: insights from an Institute of Medicine report. JAMA 2013; 310 (12) 1227-1228
- 6 Quan H, Sundararajan V, Halfon P. , et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43 (11) 1130-1139
- 7 Robinson JC, Pozen A, Tseng S, Bozic KJ. Variability in costs associated with total hip and knee replacement implants. J Bone Joint Surg Am 2012; 94 (18) 1693-1698
- 8 Robinson BR, Pritts TA, Hanseman DJ, Wilson GC, Abbott DE. Cost discrepancies for common acute care surgery diagnoses in Ohio: influences of hospital characteristics on charge and payment differences. Surgery 2014; 156 (04) 814-822
- 9 Lee CC, Kimmell KT, Lalonde A. , et al. Geographic variation in cost of care for pituitary tumor surgery. Pituitary 2016; 19 (05) 515-521
- 10 Williams JS, Bishu K, Dismuke CE, Egede LE. Sex differences in healthcare expenditures among adults with diabetes: evidence from the medical expenditure panel survey, 2002-2011. BMC Health Serv Res 2017; 17 (01) 259
- 11 Propper B, Black III JH, Schneider EB. , et al. Hispanic ethnicity is associated with increased costs after carotid endarterectomy and carotid stenting in the United States. J Surg Res 2013; 184 (01) 644-650
- 12 Schneider EB, Black III JH, Hambridge HL. , et al. The impact of race and ethnicity on the outcome of carotid interventions in the United States. J Surg Res 2012; 177 (01) 172-177
- 13 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
- 14 Fu S, Lairson DR, Chan W, Wu CF, Ramondetta L. Mean medical costs associated with vaginal and vulvar cancers for commercially insured patients in the United States and Texas. Gynecol Oncol 2018; 148 (02) 342-348
- 15 Sonig A, Khan IS, Wadhwa R, Thakur JD, Nanda A. The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005-2009). Neurosurg Focus 2012; 33 (03) E3
- 16 McGuire KJ, Chacko AT, Bernstein J. Cost-effectiveness of teaching hospitals for the operative management of hip fractures. Orthopedics 2011; 34 (10) e598-e601
- 17 Taylor Jr DH, Whellan DJ, Sloan FA. Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. N Engl J Med 1999; 340 (04) 293-299
- 18 Goodchild M, Nargis N, Tursan d'Espaignet E. Global economic cost of smoking-attributable diseases. Tob Control 2018; 27 (01) 58-64
- 19 Thomas JG, Gadgil N, Samson SL, Takashima M, Yoshor D. Prospective trial of a short hospital stay protocol after endoscopic endonasal pituitary adenoma surgery. World Neurosurg 2014; 81 (3, 4): 576-583
- 20 Sarkiss CA, Lee J, Papin JA. , et al. Pilot study on early postoperative discharge in pituitary adenoma patients: effect of socioeconomic factors and benefit of specialized pituitary centers. J Neurol Surg B Skull Base 2015; 76 (04) 323-330
- 21 Dahm P, Tuttle-Newhall JE, Nimjee SM, Byrne RR, Yowell CW, Price DT. Indications for admission to the surgical intensive care unit after radical cystectomy and urinary diversion. J Urol 2001; 166 (01) 189-193
- 22 Yousef Y, Youssef F, Dinh T. , et al. Risk stratification in pediatric perforated appendicitis: prospective correlation with outcomes and resource utilization. J Pediatr Surg 2018; 53 (02) 250-255