title: Predictors of access to pituitary tumor resection in the United States, 1988-2005.
abstract: OBJECTIVE
  Surgery remains a common form of treatment for sellar and parasellar tumors involving the pituitary gland and adjacent structures. Studies have suggested that pituitary surgery procedures performed at high-volume centers are associated with less adverse outcomes, yet it remains unclear which types of patients are more likely to be admitted to such centers. We set out to determine which factors most influenced admission to these high-volume centers.
  
  
  METHODS
  A retrospective analysis of the National Inpatient Sample over an 18-year period was linked to socioeconomic and environmental data contained within the Area Resource File. Only patients undergoing transsphenoidal surgery in the United States, >18-years-old were included. The primary outcome was admission to a high-volume (>25 pituitary surgeries/year) hospital.
  
  
  RESULTS
  Overall, patients' odds of admission to a high-volume center increased over an 18-year time period. However, African-Americans (odds ratio, OR=0.46), Hispanics (OR=0.28), and Asians (OR=0.49) experienced declining odds of admission over time. Patients from high-income brackets (OR=1.53) and from areas with higher neurosurgeon density (OR=1.61) were more likely to be admitted to high-volume centers. Conversely, patients coming from counties with higher poverty (OR=0.92) were less likely to be admitted to high-volume centers.
  
  
  CONCLUSIONS
  Racial and socioeconomic factors play a significant role in the admission of patients to high-volume pituitary surgery centers. This study demonstrates potential key policy areas for meaningful intervention to help ease disparities in access to quality care for surgical pituitary disease.
authors.affiliation: Brain Tumor Stem Cell and Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II, Room 253, Baltimore, Maryland 21231, USA.
authors.forename: Debraj
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.forename: Thomas
authors.initials: T
authors.lastname: Kosztowski
authors.forename: Kaisorn L
authors.initials: KL
authors.lastname: Chaichana
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvatori
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007016:Hypophysectomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States