title: Variations in referral patterns for hypophysectomies among pediatric patients with sellar and parasellar tumors.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Suite 253, Baltimore, MD 21231, USA.
authors.forename: Debraj
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Kosztowski
authors.forename: Aditya
authors.initials: A
authors.lastname: Halthore
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
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: D000293:Adolescent; D000367:Age Factors; D001932:Brain Neoplasms / Q000208:ethnology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007016:Hypophysectomy; D019458:Insurance Coverage; D008297:Male; D010911:Pituitary Neoplasms / Q000208:ethnology / Q000601:surgery*; D011203:Poverty; D044469:Racial Groups; D012017:Referral and Consultation; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014481:United States