{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:25:45Z","timestamp":1786976745953,"version":"build-2736575974"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,7,14]],"date-time":"2018-07-14T00:00:00Z","timestamp":1531526400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged length of stay (pLOS), disease\u2010related complications, and 30\u2010day readmissions are important quality metrics under the Affordable Care Act. The purpose of our study was to investigate the effect of patient\u2010level and hospital\u2010level factors on these outcomes for patients admitted for transsphenoidal pituitary surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Statewide Planning and Research Cooperative System (SPARCS) database was queried to investigate 30\u2010day readmissions and pLOS for transsphenoidal pituitary surgery in New York from 1995 to 2015. Multivariate logistic regression, adjusting for patient and hospital characteristics, was performed to assess the effect of these variables on the outcomes of interest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 9950 patients underwent transsphenoidal pituitary surgery; 7122 (72%), 2394 (24%), and 434 (4%) patients were treated at high\u2010volume, medium\u2010volume, and low\u2010volume centers, respectively. Patient factors associated with treatment at high\u2010volume centers (HVCs) included: top income quartile, private insurance, urban residence, and white or Asian race (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Patient variables associated with treatment at low\u2010volume centers (LVCs) included: age &gt;65 years, elevated Charlson comorbidity index (CCI) scores, bottom income quartile, Medicaid and Medicare insurance, rural residence, black race, and Hispanic ethnicity (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Variables predictive of prolonged hospitalizations in our multivariable model included black race, Hispanic ethnicity, Medicaid insurance, low income, female gender, LVC, and comorbidities (panhypopituitarism, hypothyroidism, diabetes insipidus [DI], visual disturbances, CCI) while predictors of readmissions included Asian race, female gender, and comorbidities (Cushing syndrome, DI, CCI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients undergoing transsphenoidal pituitary surgery at HVCs have shorter hospitalizations, fewer postoperative electrolyte abnormalities, and lower charges; however, socioeconomic factors may influence access to quality care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.22148","type":"journal-article","created":{"date-parts":[[2018,7,14]],"date-time":"2018-07-14T06:01:41Z","timestamp":1531548101000},"page":"1145-1156","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015"],"prefix":"10.1002","volume":"8","author":[{"given":"Sean","family":"McKee","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Icahn School of Medicine at Mount Sinai  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Icahn School of Medicine at Mount Sinai  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Kidwai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Icahn School of Medicine at Mount Sinai  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satish","family":"Govindaraj","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Icahn School of Medicine at Mount Sinai  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Shrivastava","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Icahn School of Medicine at Mount Sinai  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Iloreta","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Icahn School of Medicine at Mount Sinai  New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3182a7f76f"},{"key":"e_1_2_6_3_1","unstructured":"Centers for Medicare and Medicaid Services.Bundled Payments for Care Improvement (BPCI).https:\/\/innovation.cms.gov\/initiatives\/bundled-payments\/. 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