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J Neurol Surg B Skull Base 2018; 79(06): 522-527
DOI: 10.1055/s-0038-1635081
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Costs in Pituitary Surgery: Racial, Socioeconomic, and Hospital Factors

Arjun K. Parasher
1   Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Alan D. Workman
2   Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Sarah M. Kidwai
3   Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Erden Goljo
3   Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Anthony Del Signore
3   Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Alfred M. Iloreta
3   Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Eric M. Genden
3   Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Raj Shrivastava
3   Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Amol Navathe
1   Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Satish Govindaraj
3   Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
› Author Affiliations Funding The authors have no funding, financial relationships, or conflicts of interest to disclose.
Further Information

Publication History

14 September 2017

07 January 2018

Publication Date:
21 March 2018 (online)

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Abstract

Objective To investigate the influence of patient demographic factors and hospital factors on cost and length of stay in patients undergoing pituitary surgery.

Design/Setting A retrospective cross-sectional study of the 2008 to 2012 Nationwide/National Inpatient Sample.

Participants Patient demographics and hospital characteristics for patients undergoing pituitary surgery were compared between white, black, and Hispanic patients.

Main Outcome Measures 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 Of 8,812 patients who underwent pituitary surgery, 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 racial groups via univariate analysis were age, chronic conditions, gender, income, and primary payer. Hospital variables found to be significantly different were location/teaching status, region, and ownership. Hospitalization cost was significantly lower for whites (−$3,082, 95% confidence interval [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–$4,152). Length of hospital stay was also 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 0.57–1.35).

Conclusions Racial and ethnic factors contribute to differences in hospital utilization and cost for patients undergoing pituitary surgery. Further investigations are necessary to uncover the sources of these disparities in an effort to provide safer and more affordable care to all patients.

Keywords

pituitary surgery - skull base - health care disparities - cost - outcomes/cost-effectiveness
 

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