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Updated: Jun 18, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Variations in referral patterns for hypophysectomies among pediatric patients with sellar and parasellar tumors
Debraj Mukherjee1, Hasan A Zaidi, Thomas A Kosztowski
1Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Suite 253, Baltimore, MD 21231, USA.
Insights
Pediatric patients with sellar/parasellar lesions face disparities in accessing high-volume neurosurgical centers. Hispanic children and younger patients are less likely to receive care at these specialized centers, impacting outcomes.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Healthcare Disparities
Background:
- High-volume hospitals are associated with better outcomes for complex surgeries like sellar/parasellar lesion resection.
- Factors influencing pediatric patient access to these specialized centers remain understudied.
Purpose of the Study:
- To identify preoperative factors associated with pediatric patients (<18 years) being admitted to high-volume neurosurgical centers for sellar/parasellar lesion resection.
- To analyze nationwide data on pediatric neurosurgical interventions for these specific lesions.
Main Methods:
- Retrospective analysis of the Nationwide Inpatient Sample (NIS) and Area Resource File.
- Identification of pediatric patients (<18 years) undergoing resection of pituitary or related sellar/parasellar tumors using ICD-9 codes.
- Multivariate logistic regression analysis of covariates including age, gender, race, and insurance status.
Main Results:
- 1,063 pediatric patients were identified; 69.8% were treated at low-volume centers.
- Hispanic children were 44% less likely to access high-volume centers compared to Caucasian children (OR 0.56, p<0.05).
- Older pediatric patients (per 2-year age category) had increased access to high-volume centers (OR 1.12, p<0.05).
Conclusions:
- Significant age and racial disparities exist in accessing high-volume neurosurgical care for pediatric patients with sellar/parasellar lesions in the USA.
- These disparities may influence the quality and outcomes of care for this vulnerable population.
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 >or=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.
