Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Rhinol Allergy. 2023 Nov;37(6):758-765. doi: 10.1177/19458924231193527. Epub 2023 Aug 7.
In this nationwide retrospective study, the authors aimed to identify demographic, clinical, and baseline health risk factors predictive of a prolonged length of stay (PLOS) for patients with pituitary adenomas (PAs).
The National Inpatient Sample dataset from 2016 to 2019 was utilized to identify all included hospitalizations for PA resection as identified by the appropriate diagnosis-related group code. Comorbidities were classified based on the Charlson Comorbidity Index mapping of codes, and PLOS was identified as any stay longer than 3 days. Univariable and multivariable logistic regression models, accounting for the sample design, were built to determine factors associated with PLOS and emergent surgery.
Overall, 30 945 patients were included in this study with 10 535 patients having PLOS. Female patients experienced an increased odds of PLOS (odds ratio [OR]: 1.29; < .001). Black patients (OR: 1.49; < .001) and Hispanic patients (OR: 1.30; = .003) had 1.49 times and 1.30 times the odds of PLOS compared to White patients, respectively. Compared to patients insured by Medicare, patients insured by Medicaid had an increased odds of PLOS (OR: 1.36; = .007) as well as emergent surgery (OR: 5.40; < .001). When stratified by emergent surgeries, Black patients (OR: 1.89; < .001), Hispanic patients, (OR: 2.14; < .001), and patients on Medicaid insurance (OR: 1.71; < .001) were at an increased risk of emergent procedures. However, female sex (OR: 0.65; < .001), upper third quartile (OR: 0.73; = .017), and fourth quartile (OR: 0.69; = .014) of patients categorized by zip code income were at decreased odds of an emergent procedure.
Black and Hispanic patients, patients with Medicaid insurance, and patients of low socioeconomic status patients are at significantly higher risk of emergent PA resection and PLOS. Efforts to prevent emergent surgeries and shorten hospitalization after pituitary surgery may need to primarily focus on patient groups with select sociodemographic characteristics.
在这项全国性回顾性研究中，作者旨在确定预测垂体腺瘤 (PA) 患者住院时间延长 (PLOS) 的人口统计学、临床和基线健康风险因素。
利用 2016 年至 2019 年国家住院患者样本数据集，通过适当的诊断相关组代码确定所有纳入的 PA 切除术住院患者。根据 Charlson 合并症指数对代码进行分类，并将 PLOS 定义为任何超过 3 天的住院时间。采用考虑样本设计的单变量和多变量逻辑回归模型，确定与 PLOS 和紧急手术相关的因素。
总体而言，本研究共纳入 30945 例患者，其中 10535 例患者 PLOS。女性患者 PLOS 的可能性增加（优势比 [OR]：1.29；<.001）。与白人患者相比，黑人患者（OR：1.49；<.001）和西班牙裔患者（OR：1.30；=.003）的 PLOS 可能性分别增加 1.49 倍和 1.30 倍。与医疗保险患者相比，医疗补助保险患者 PLOS（OR：1.36；=.007）和紧急手术（OR：5.40；<.001）的可能性增加。按紧急手术分层，黑人患者（OR：1.89；<.001）、西班牙裔患者（OR：2.14；<.001）和医疗补助保险患者（OR：1.71；<.001）紧急手术的风险增加。然而，女性（OR：0.65；<.001）、上三分之一四分位数（OR：0.73；=.017）和第四四分位数（OR：0.69；=.014）的患者按邮政编码收入分类的可能性降低接受紧急手术。
黑人和西班牙裔患者、医疗补助保险患者和社会经济地位较低的患者发生紧急 PA 切除术和 PLOS 的风险显著增加。预防紧急手术和缩短垂体手术后的住院时间的努力可能需要主要集中在具有特定社会人口统计学特征的患者群体上。
