J Neurol Surg B Skull Base 2021; 82(02): 175-181
DOI: 10.1055/s-0040-1701218
Original Article

Transsphenoidal Resection of Pituitary Tumors in the United States, 2009 to 2011: Effects of Hospital Volume on Postoperative Complications

1   Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
,
1   Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
,
Brendan Martin
2   Biostatistics Collaborative Core, Clinical Research Office, Loyola University Chicago, Chicago, Illinois, United States
,
Adrienne Cobb
3   Department of General Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
,
Miri Kim
1   Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
,
Anand V. Germanwala
1   Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
› Author Affiliations

Abstract

Introduction Higher surgical volumes correlate with superior patient outcomes for various surgical pathologies, including transnasal transsphenoidal (TNTS) pituitary tumor resection. With the introduction of endoscopic approaches, there have been nationwide shifts in technique with relative declines in microsurgery. We examined the volume-outcome relationship (VOR) for TNTS pituitary tumor surgery in an era of increasingly prevalent endoscopic approaches.

Methods Patients who underwent TNTS pituitary tumor resection between 2009 and 2011 were retrospectively identified in the State Inpatient Database subset of the Healthcare Cost and Utilization Project. Generalized linear mixed-effect models were used to assess odds of various outcome measures. Institutions were grouped into quartiles by case volume for analysis.

Results A total of 6,727 patients underwent TNTS pituitary tumor resection between 2009 and 2011. White or Asian American patients and those with private insurance were more likely to receive care at higher volume centers (HVC). Patients treated at HVC (>60 cases/year) were less likely to have nonroutine discharges (3.9 vs. 1.9%; p = 0.002) and had shorter length of stay (LOS; 4 vs. 2 days; p = 0.001). Overall, care at HVC trended toward lower rates of postoperative complications, for example, a 10-case/year increase correlated with a 10% decrease in the rate of iatrogenic panhypopituitarism (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.81–0.99; p = 0.04) and 5% decrease in likelihood of diabetes insipidus (OR = 0.95, 95% CI: 0.90–0.99; p = 0.04) on multivariable analysis.

Conclusions Our analysis shows that increased case volume is related to superior perioperative outcomes for TNTS pituitary tumor resections. Despite the recent adoption of newer endoscopic techniques and concerns of technical learning curves, this VOR remains undisturbed.



Publication History

Received: 18 April 2019

Accepted: 29 August 2019

Article published online:
24 January 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Cobb AN, Wong YM, Brownlee SA. et al. Perioperative support, not volume, is necessary to optimize outcomes in surgical management of necrotizing enterocolitis. Am J Surg 2017; 213 (03) 502-506
  • 2 Bach PB, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB. The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 2001; 345 (03) 181-188
  • 3 Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349 (22) 2117-2127
  • 4 Dimick JB, Upchurch Jr GR. Endovascular technology, hospital volume, and mortality with abdominal aortic aneurysm surgery. J Vasc Surg 2008; 47 (06) 1150-1154
  • 5 Davies JM, Ozpinar A, Lawton MT. Volume-outcome relationships in neurosurgery. Neurosurg Clin N Am 2015; 26 (02) 207-218
  • 6 Kalakoti P, Ahmed O, Bollam P, Missios S, Wilden J, Nanda A. Predictors of unfavorable outcomes following deep brain stimulation for movement disorders and the effect of hospital case volume on outcomes: an analysis of 33, 642 patients across 234 US hospitals using the National (Nationwide) Inpatient Sample from 2002 to 2011. Neurosurg Focus 2015; 38 (06) E4
  • 7 De la Garza-Ramos R, Abt NB, Kerezoudis P, Krauss W, Bydon M. Provider volume and short-term outcomes following surgery for spinal metastases. J Clin Neurosci 2016; 24: 43-46
  • 8 Trinh VT, Davies JM, Berger MS. Surgery for primary supratentorial brain tumors in the United States, 2000-2009: effect of provider and hospital caseload on complication rates. J Neurosurg 2015; 122 (02) 280-296
  • 9 Rinaldo L, McCutcheon BA, Murphy ME. et al. Quantitative analysis of the effect of institutional case volume on complications after surgical clipping of unruptured aneurysms. J Neurosurg 2017; 127 (06) 1297-1306
  • 10 Bekelis K, Connolly ID, Do HM, Choudhri O. Operative volume and outcomes of cerebrovascular neurosurgery in children. J Neurosurg Pediatr 2016; 18 (05) 623-628
  • 11 O'Malley Jr BW, Grady MS, Gabel BC. et al. Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve. Neurosurg Focus 2008; 25 (06) E10
  • 12 Singh H, Essayed WI, Cohen-Gadol A, Zada G, Schwartz TH. Resection of pituitary tumors: endoscopic versus microscopic. J Neurooncol 2016; 130 (02) 309-317
  • 13 Zaidi HA, Awad AW, Bohl MA. et al. Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg 2016; 124 (03) 596-604
  • 14 Eseonu CI, ReFaey K, Rincon-Torroella J. et al. Endoscopic versus microscopic transsphenoidal approach for pituitary adenomas: Comparison of outcomes during the transition of methods of a single-surgeon. World Neurosurg 2017; 97: 317-325
  • 15 Shahlaie K, McLaughlin N, Kassam AB, Kelly DF. The role of outcomes data for assessing the expertise of a pituitary surgeon. Curr Opin Endocrinol Diabetes Obes 2010; 17 (04) 369-376
  • 16 Barker II FG, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 2003; 88 (10) 4709-4719
  • 17 Rolston JD, Han SJ, Aghi MK. Nationwide shift from microscopic to endoscopic transsphenoidal pituitary surgery. Pituitary 2016; 19 (03) 248-250
  • 18 Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: an overview. Eff Clin Pract 2002; 5 (03) 143-151
  • 19 American Hospital Association. The AHA Annual Survey Database. Accessed September 18, 2019 at: https://www.ahadataviewer.com/additional-data-products/AHA-Survey/
  • 20 Haut ER, Pronovost PJ, Schneider EB. Limitations of administrative databases. JAMA 2012; 307 (24) 2589-2590 , author reply 2589–2590
  • 21 Stulberg JJ, Haut ER. Practical guide to surgical data sets: healthcare cost and utilization project national inpatient sample (NIS). JAMA Surg 2018; 153 (06) 586-587
  • 22 Ward BK, Gourin CG, Francis HW. Vestibular schwannoma surgical volume and short-term outcomes in Maryland. Arch Otolaryngol Head Neck Surg 2012; 138 (06) 577-583