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.
Keywords
pituitary tumor - transsphenoidal - volume-outcome relationship
