1377. Comparing performance and outcome measures in hospitalized pituitary tumor patients with secretory versus non-secretory tumors
Authors: Alexander Vlasak; David Shin, MD; Maryam Rahman, MD, MS; Paul Kubilis, MS; Aida Karachi, DVM, PhD (Gainesville, FL)
Patient safety indicators (PSIs) and hospital acquired conditions (HACs) are reported quality measures that are increasingly important for performance monitoring and reimbursement for health care institutions. We compared PSI and HAC prevalence in secretory and non-secretory pituitary adenoma patients using the National Inpatient Sampling (NIS) database.
The NIS was queried for hospitalizations between 2002 and 2014 involving management of pituitary adenomas. PSI, HAC, and nine pituitary-related complications (i.e. pituitary apoplexy and diabetes insipidus) prevalence in administrative records was determined using ICD-9 codes. Multivariate analysis was applied to evaluate patient risk factors across this cohort.
Among 24,128 pituitary tumor patients, 20,743 patients were identified with non-secretory tumors (median age 55 years) and 3,385 with secretory tumors (median age 43 years). Among non-secretory tumor patients 3.79% had any PSI or HAC. Of secretory tumor patients 2.54% had any PSI or HAC. Before adjusting for covariation between groups, secretory patients were less likely to suffer any PSIs or HACs (odds ratio [OR]=0.652, p=0.0002), experience any pituitary-related complication (OR=0.804, p<.0001), have a poor outcome (hazard ratio[HR]=0.435, p<0.0001), and die during hospitalization (HR=0.293, p=0.0015). They had significantly shorter mean hospital length of stay (LOS) (Sec:Non-Sec Percent Difference [PD]= -11.95%, p<0.0001). However, after completing inverse propensity score-weighted odds ratios comparing the two groups’ outcomes there was no significant difference in the incidence of any PSIs and HACs (OR=0.963, p=0.8570), pituitary-related complications (OR=.894, p=0.1321), poor outcomes (HR=0.990, p=0.9287), in-hospital death (HR=0.663, p=0.2967), and LOS (PD= -2.31%, p=0.2967) between groups.
Lack of statistically significant difference in the outcome measures of these two groups after controlling for covariation between them likely indicates that non-secretory tumor patients have more comorbidities at the time of presentation for surgery. Additionally, PSIs and HACs are a relatively weak measure of the complications associated with pituitary tumors.