Association between facility volume with treatment patterns and short-term surgical outcomes in pituitary adenoma: a National Cancer Database analysis.

Abstract

Objective: Pituitary adenomas (PAs) are common intracranial neoplasms for which definitive treatment is generally transsphenoidal resection depending on patient and tumor characteristics. Recent studies have demonstrated that patients with other intracranial tumors treated at high-volume centers are more likely to undergo surgery, receive adjuvant therapy, and experience improved surgical outcomes. However, PAs have yet to be studied in this context. The authors investigated the association between facility volume with treatment patterns and short-term surgical outcomes in patients with PA using data from the National Cancer Database (NCDB).

Methods: The NCDB was queried for adult patients diagnosed with PA between 2010 and 2021. Facility volume was categorized into quartiles based on the average number of patients managed per year: quartile 1 (Q1, ≤ 8.73), quartile 2 (Q2, 8.74-20.60), quartile 3 (Q3, 20.61-48.40), and quartile 4 (Q4, ≥ 48.41). Multivariable logistic regression models were constructed to assess treatment patterns and short-term surgical outcomes (extended length of stay [> 4 days], unplanned 30-day readmission, 30-day mortality, and 90-day mortality), adjusting for patient sociodemographic and clinical characteristics.

Results: A total of 100,471 patients treated at 1227 hospitals were included. The majority of hospitals were in Q1 (79.1%), while 28 hospitals (2.3%) qualified for Q4. Patients at Q4 hospitals were more likely to undergo surgery (OR 2.08, 95% CI 1.97-2.20) and receive medical therapy (OR 2.40, 95% CI 2.24-2.57) compared with patients at Q1 hospitals (both p < 0.001). Endoscopic surgery was more frequently performed at Q4 hospitals (70.8%) than Q1 hospitals (45.0%). Compared with patients at Q1 hospitals, patients at Q4 hospitals demonstrated lower odds of receiving radiotherapy (OR 0.68, 95% CI 0.58-0.80; p < 0.001). Patients treated at Q4 hospitals exhibited a lower likelihood of extended postsurgical length of stay (OR 0.54, 95% CI 0.49-0.59), 30-day mortality (OR 0.42, 95% CI 0.27-0.65), and 90-day mortality (OR 0.52, 95% CI 0.37-0.73) in comparison with patients at Q1 hospitals (all p < 0.001). However, no significant difference in unplanned readmission within 30 days of surgery (OR 0.95, 95% CI 0.79-1.15; p = 0.615) was observed between Q4 and Q1 hospitals.

Conclusions: Treatment at higher-volume facilities is associated with higher odds of undergoing surgery, along with significantly lower odds of extended postsurgical length of stay and perioperative mortality. These findings highlight the importance of centralized care at high-volume institutions, where multidisciplinary teams can offer comprehensive management for complex cases.