Association Between Facility Type with Treatment Patterns and Short-term Surgical Outcomes in Pituitary Adenoma: A National Cancer Database Analysis

Introduction: 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 improved surgical outcomes for patients with other intracranial tumors at high-volume and academic centers, but PAs have yet to be studied within this context. We investigated the association between facility type 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 2019. Facility type was categorized into academic programs (APs) and non-academic programs (NAPs). Multivariable logistic regression models were constructed to assess treatment patterns and short-term surgical outcomes (extended length of stay, unplanned thirty day readmission, and thirty day mortality), adjusting for patient sociodemographic and clinical characteristics.

Results: A total of 64,254 patients were included. Patients at APs were more likely to receive surgery (OR 1.88, 95% CI 1.80-1.97) and hormone therapy (OR 1.53, 95% CI 1.43-1.64) compared to patients at NAPs (both p< 0.001). Endoscopic surgery was more frequently performed at APs (61.9%) than NAPs (50.5%). Compared to patients at APs, patients at NAPs (OR 1.28, 95% CI 1.13-1.44) demonstrated higher odds of receiving radiotherapy. Patients treated at NAPs exhibited a higher likelihood of extended postsurgical length of stay (OR 1.12, 95% 1.05-1.21) and unplanned thirty day readmission (OR 1.20, 95% CI 1.02-1.41), but not thirty day mortality (OR 1.26, 95% 0.92-1.73) in comparison to patients at APs.

Conclusion : Treatment at APs is associated with higher odds of receiving surgery and hormonal therapy, along with significantly lower odds of extended length of stay and unplanned thirty day readmission after surgery. These findings highlight the importance of centralized care at high-volume academic institutions, where multidisciplinary teams can offer comprehensive management for complex cases.