Variations in referral patterns for hypophysectomies among pediatric patients with sellar and parasellar tumors

Debraj Mukherjee, Hasan A. Zaidi, Thomas A. Kosztowski, Aditya Halthore, George I. Jallo, Roberto Salvatori, David C. Chang, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Purpose: It has been shown that patients admitted to high-volume hospitals for resection of sellar and parasellar lesions experience reduced mortality and morbidity. It remains unknown what preoperative factors influence admission to high-volume centers. We report a nationwide analysis of patients <18 years of age undergoing neurosurgical intervention for these lesions. Methods: A retrospective analysis of the Nationwide Inpatient Sample was performed with additional factors from the Area Resource File. International Classification of Diseases, 9th Revision diagnosis/procedural codes were used to identify patients undergoing resection of tumors from the pituitary gland or related structures. Patients <18 years old were excluded. Covariates included age, gender, race, and insurance status. Multivariate analysis was performed using multiple logistic regression models. A p value <0.05 was considered statistically significant. Results: In total, 1,063 patients were identified. Most (69.8%) were seen at low-volume centers. Mean (median) patient age was 13.7 (15) years. The majority of patients were female (54.8%), white (61.9%), and insured (90.3%). Hispanics were 44% less likely (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.34-0.92, p < 0.05) to be seen at high-volume centers than their Caucasian counterparts. Each increase in 2-year patient age category was associated with greater access to high-volume centers (OR 1.12, 95% CI 1.03-1.23, p < 0.05), relative to 0-2 years old. Female gender, insurance status, county poverty, neurosurgeon density, and calendar year were not significantly associated with admission to high-volume centers. Conclusions: Age and racial disparities play a significant role in access neurosurgical care, affecting admission of pediatric patients to high-volume neurosurgical centers across the USA.

Original languageEnglish (US)
Pages (from-to)305-311
Number of pages7
JournalChild's Nervous System
Volume26
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

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Keywords

  • Access
  • Disparities
  • Hypophysectomy
  • Pediatric sellar/parasellar tumors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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