Comparing Standard Performance and Outcome Measures in Hospitalized Pituitary Tumor Patients with Secretory versus Nonsecretory Tumors

• Published in: World neurosurgery 2020-03, Vol.135, p.e510-e519
• Main Authors: Vlasak, Alexander L., Shin, David H., Kubilis, Paul S., Roper, Steven N., Karachi, Aida, Hoh, Brian L., Rahman, Maryam
• Format: Article
• Language: English
• Subjects: Adenoma - complications; Adult; Agency for Healthcare Research Quality (AHRQ); Brain tumor; Female; Hospital-acquired condition (HAC); Hospitalization; Humans; Male; Middle Aged; National (Nationwide) Inpatient Sample; Patient safety indicator (PSI); Pituitary adenoma; Pituitary Neoplasms - complications; Prognosis; Quality measures; Retrospective Studies; Risk Factors
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.12.059

Patient safety indicators (PSIs) and hospital-acquired conditions (HACs) are reported quality measures. We compared their prevalence in patients with secretory and nonsecretory pituitary adenoma using the National (Nationwide) Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. The NIS was queried for hospitalizations 2002–2014 involving pituitary adenomas. Prevalence of PSI, HAC, and 9 pituitary-related complications was determined using International Classification of Diseases, Ninth Revision codes. Patient risk factors were evaluated through multivariate analysis. A total of 20,743 patients with nonsecretory tumor and 3385 patients with secretory tumor were identified. Among patients with nonsecretory tumor, 3.79% experienced any PSI or HAC. Of patients with secretory tumor, 2.54% had any PSI or HAC. Before adjusting for covariation, secretory patients were less likely to have any PSI or HAC (odds ratio [OR], 0.652; P = 0.0002), experience any pituitary-related complication (OR, 0.804; P < 0.0001), have a poor outcome (hazard ratio [HR], 0.435; P < 0.0001), and die during hospitalization (HR, 0.293; P = 0.0015). Secretory patients had significantly shorter mean hospital length of stay (secretory/nonsecretory percent difference, –11.95%; P < 0.0001). However, inverse propensity score–weighted ORs comparing the groups' outcomes showed that there was no significant difference in the prevalence of any PSIs and HACs (OR, 0.963; P = 0.8570), pituitary-related complications (OR, 0.894; P = 0.1321), poor outcomes (HR, 0.990; P = 0.9287), in-hospital death (HR, 0.663; P = 0.2967), and length of stay (percent difference, –2.31%; P = 0.2967) between groups. Lack of significant difference in outcome measures after controlling for covariation is consistent with our finding that patients with nonsecretory tumor have more comorbidities on presentation for treatment. PSIs and HACs have limited ability to measure complications specific to pituitary tumors.