Pituitary adenoma management and outcomes according to hospital case volume and facility type.

Abstract

Objectives: This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma (PA).

Methods: The 2004-2016 National Cancer Database was queried for patients with PA receiving definitive treatment. Tumor size represented the largest diameter of the primary tumor.

Results: A total of 89,863 patients (53.8% female) with a mean age and tumor size of (51.0 ± 18.0) years (Mean ± SD, later the same) and (19.5 ± 13.2) mm, respectively, were included. Patients were managed at 1,241 unique facilities, categorized into 1057 low-volume (treating approximately <10 patients annually), 142 intermediate-volume (treating approximately 10-30 patients annually), and 42 high-volume facilities (treating approximately 31-105 patients annually). Increasing facility volume and academic centers were both associated with higher rates of surgical treatment as well as lower rates of radiotherapy and shorter postoperative length of hospitalization (all p < 0.001). Kaplan-Meier log-rank analysis showed that increasing facility volume and academic centers were both significantly associated with improved overall survival (p < 0.001). On multivariate Cox-regression analysis after adjusting for age, gender, Charlson-Deyo comorbidity index, tumor size, treatment type, and facility type, treatment at intermediate-volume (HR 1.238, 95% CI 1.155-1.329, p < 0.001) and low-volume facilities (HR = 1.413, 95% CI 1.306-1.528, p < 0.001) were independent risk factors of all-cause mortality, while facility type was not independently associated with overall survival.

Conclusion: Management and outcomes of PA appear to be dependent on the treatment facility volume, with high-volume facilities, but not necessarily facility type, being associated with improved outcomes overall.