Social determinants of health and increased length of stay following endoscopic endonasal pituitary surgery.

Abstract

Objective: Socioeconomic disparities are increasingly recognized as contributors to variable healthcare outcomes, including hospital length of stay (LOS). This study investigates how social factors, including the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), influence postoperative LOS in patients undergoing endoscopic endonasal pituitary surgery.

Methods: The authors retrospectively analyzed patients undergoing endoscopic transsphenoidal resection of pituitary adenoma or cyst at a single academic institution between January 2021 and December 2024. SVI scores and ADI percentiles were assigned based on ZIP codes. LOS comparisons across social variables were performed using Wilcoxon rank-sum, Pearson's chi-square, and Fisher's exact tests. Linear regression was used to assess the relationship between LOS, SVI, and ADI. Univariate and multivariable logistic regression were used to identify predictors of prolonged LOS (PLOS; > 3 days).

Results: Overall, 158 patients (53% male, mean age 53 years) were included in this analysis, with a mean LOS of 4.58 days (SD 3.33 days). In the univariate analysis, female sex (p = 0.008), unemployment (p = 0.040), unmarried status (p = 0.016), lack of a primary care provider (p = 0.012), and an ADI > 50th percentile (p = 0.014) were associated with PLOS. Postoperative diabetes insipidus showed a strong association with PLOS (p < 0.001). Linear regression demonstrated that higher ADI percentiles (r = 0.211, p = 0.012) and larger tumors (r = 0.234, p = 0.005) predicted longer LOS. In the multivariable model, postoperative diabetes insipidus (OR 62.80, 95% CI 12.09-510.67, p < 0.001), unemployment (OR 9.00, 95% CI 2.06-50.54, p = 0.006), and unmarried status (OR 9.45, 95% CI 2.45-47.26, p = 0.003) independently predicted PLOS.

Conclusions: Social determinants of health, particularly a higher ADI percentile and unemployment, were associated with prolonged hospitalization following endoscopic pituitary surgery. These findings highlight the impact of social determinants on the postoperative course and surgical recovery. Increased understanding of these associations might enable interventions to reduce LOS and related healthcare costs.