Socioeconomic Disparities in the Utilization of Endoscopic Transsphenoidal Pituitary Surgery: A Retrospective Analysis of the National Inpatient Sample

Background: Pituitary neoplasms account for 15% of all intracranial neoplasms and affect 20% of the population. Disparities in treatment and outcomes may exist across racial, socioeconomic, and insurance groups, warranting further investigation. Methods: The National Inpatient Sample was analyzed from 2010 to 2020. Pearson's chi(2) test, Fisher's exact test, and independent 2-tailed t-test were used to assess patient characteristics and outcomes. Common complications such as cerebrospinal fluid leak, diabetes insipidus, iatrogenic pituitary disorder, fluid and electrolyte disorders, neurological disorders, pulmonary disorders, and less common complications were assessed. A logistic regression model was used to compare in-hospital mortality and postoperative complications between racial groups. Statistically significant postoperative complications were analyzed with a multivariable logistic regression to determine the independent impact of obesity on postoperative outcomes. Results: Hospitalization rates for this procedure declined significantly over the decade, from 10,279 in 2010 to 5875 in 2020 (trend P value < 0.001). The majority of patients were aged between 25 and 64 years (72.16%), with 60.73% having no comorbidities. While the gender distribution was nearly even, disparities emerged across racial and socioeconomic groups. Black and Hispanic patients were more likely to reside in lower income zip codes and depend on Medicaid compared to White patients. Black patients had higher odds of any postoperative complication (adjusted odds ratio [aOR]: 1.14, P = 0.003) and specific complications like diabetes insipidus, fluid/electrolyte disorders, and renal/urinary issues compared to White patients. Both Black and Hispanic patients faced higher mortality risks postsurgery compared to White patients (aOR: 2.62 and 2.44, respectively, P < 0.05).Medicaid coverage was associated with higher odds of any complication (aOR: 1.18, P = 0.016), while private insurance was linked to lower odds (adjusted OR: 0.88, P = 0.015). Patients in the lowest income quartile had higher odds of complications compared to those in higher quartiles. Obesity independently predicted increased odds of pulmonary, renal, and hemorrhagic complications. Conclusions: Despite advancements in endoscopic endonasal pituitary surgery, disparities in access and outcomes persist across racial, socioeconomic, and insurance groups. These findings underscore the need for targeted interventions to address these inequalities and ensure equitable access to quality care.