{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T02:25:59Z","timestamp":1780539959800,"version":"3.54.1"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T00:00:00Z","timestamp":1737763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T00:00:00Z","timestamp":1737763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pituitary"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Prolonged length of stay (PLOS) can lead to resource misallocation and higher complication risks. However, there is no consensus on defining PLOS for endoscopic transsphenoidal pituitary surgery (ETPS). Therefore, we investigated the impact of varying PLOS definitions on factors associated with PLOS in patients undergoing ETPS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a retrospective review of patients with pituitary adenomas who underwent ETPS at our institution from 2012 to 2023. Patients were divided into non-PLOS and PLOS groups based on varying definitions of PLOS: &gt; median, &gt; 4 days, &gt; 75th percentile, and &gt;\u200990th percentile. Bivariate statistical analyses were conducted using Fisher\u2019s exact test, chi-square test, and t-tests. Univariate and multivariate logistic regression identified significant predictors for each PLOS definition.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Our cohort (<jats:italic>n<\/jats:italic>\u2009=\u2009808) had a mean age of 54.37\u2009\u00b1\u200916.06 years, 50.43% male, and a median LOS of 3 days. The 75th and 90th percentiles of LOS were 4 and 6 days, respectively. The way PLOS was defined influenced associated factors identified. Preoperative KPS score, non-private insurance, and non-home discharge disposition were associated with PLOS across all definitions used (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Increased preoperative tumor volumes and postoperative hyponatremia were associated with PLOS only when defined by the 75th and 90th percentiles (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Non-White race and low income were significantly associated with PLOS\u2009&gt;\u2009median while intraoperative CSF leak was a significant predictor for PLOS\u2009&gt;\u200990th percentile (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Our study highlights the variability in predictors of PLOS based on its definition and emphasizes the role of non-clinical factors on LOS.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11102-024-01483-z","type":"journal-article","created":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T18:33:15Z","timestamp":1737829995000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Correlates of prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenomas: varying definitions and non-clinical factors"],"prefix":"10.1007","volume":"28","author":[{"given":"Khushi H.","family":"Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Susic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas V.","family":"DiStefano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxon V.","family":"Knott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adham M.","family":"Khalafallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor M.","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina G.","family":"Benjamin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish H.","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoukaa B.","family":"Sargi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo J.","family":"Komotar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Ivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"issue":"9","key":"1483_CR1","doi-asserted-by":"publisher","first-page":"e2125846","DOI":"10.1001\/jamanetworkopen.2021.25846","volume":"4","author":"SM Siddique","year":"2021","unstructured":"Siddique SM, Tipton K, Leas B et al (2021) Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Netw Open 4(9):e2125846. https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.25846","journal-title":"JAMA Netw Open"},{"issue":"5","key":"1483_CR2","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1001\/archsurg.142.5.461","volume":"142","author":"KJ Brasel","year":"2007","unstructured":"Brasel KJ, Lim HJ, Nirula R, Weigelt JA (2007) Length of Stay: an appropriate quality measure? Arch Surg 142(5):461\u2013465 discussion 465\u2013466. https:\/\/doi.org\/10.1001\/archsurg.142.5.461","journal-title":"Arch Surg"},{"issue":"8","key":"1483_CR3","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1001\/jamasurg.2014.629","volume":"149","author":"RW Krell","year":"2014","unstructured":"Krell RW, Girotti ME, Dimick JB (2014) Extended length of stay after surgery: complications, Inefficient Practice, or sick patients? JAMA Surg 149(8):815\u2013820. https:\/\/doi.org\/10.1001\/jamasurg.2014.629","journal-title":"JAMA Surg"},{"issue":"2","key":"1483_CR4","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1111\/j.1525-1497.2006.00319.x","volume":"21","author":"NA Khan","year":"2006","unstructured":"Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA (2006) Association of Postoperative Complications with Hospital costs and length of stay in a Tertiary Care Center. J Gen Intern Med 21(2):177\u2013180. https:\/\/doi.org\/10.1111\/j.1525-1497.2006.00319.x","journal-title":"J Gen Intern Med"},{"issue":"1","key":"1483_CR5","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1186\/s12913-021-06972-6","volume":"21","author":"AH Hughes","year":"2021","unstructured":"Hughes AH, Horrocks D Jr, Leung C, Richardson MB, Sheehy AM, Locke CFS (2021) The increasing impact of length of stay outliers on length of stay at an Urban Academic Hospital. BMC Health Serv Res 21(1):940. https:\/\/doi.org\/10.1186\/s12913-021-06972-6","journal-title":"BMC Health Serv Res"},{"issue":"11","key":"1483_CR6","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1001\/jamasurg.2018.2648","volume":"153","author":"Y Chen","year":"2018","unstructured":"Chen Y, Scholten A, Chomsky-Higgins K et al (2018) Risk factors Associated with Perioperative complications and prolonged length of stay after laparoscopic adrenalectomy. JAMA Surg 153(11):1036\u20131041. https:\/\/doi.org\/10.1001\/jamasurg.2018.2648","journal-title":"JAMA Surg"},{"issue":"2","key":"1483_CR7","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1001\/jamafacial.2017.1771","volume":"20","author":"WW Thomas","year":"2018","unstructured":"Thomas WW, Brant J, Chen J et al (2018) Clinical factors Associated with reoperation and prolonged length of stay in free tissue transfer to oncologic Head and Neck defects. JAMA Facial Plast Surg 20(2):154\u2013159. https:\/\/doi.org\/10.1001\/jamafacial.2017.1771","journal-title":"JAMA Facial Plast Surg"},{"issue":"6 Suppl","key":"1483_CR8","doi-asserted-by":"publisher","first-page":"S138","DOI":"10.1016\/j.wneu.2014.07.017","volume":"82","author":"G Barkhoudarian","year":"2014","unstructured":"Barkhoudarian G, Zada G, Laws ER (2014) Endoscopic endonasal surgery for Nonadenomatous Sellar\/Parasellar Lesions. World Neurosurg 82(6 Suppl):S138\u2013S146. https:\/\/doi.org\/10.1016\/j.wneu.2014.07.017","journal-title":"World Neurosurg"},{"key":"1483_CR9","doi-asserted-by":"publisher","unstructured":"Laws ER, Jane JA Jr (2005) Neurosurgical Approach to treating Pituitary Adenomas. Growth horm IGF res. 15 suppl A:S36-S41. https:\/\/doi.org\/10.1016\/j.ghir.2005.06.008","DOI":"10.1016\/j.ghir.2005.06.008"},{"issue":"6","key":"1483_CR10","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/s1072-7515(01)01101-2","volume":"193","author":"JA Jane Jr","year":"2001","unstructured":"Jane JA Jr, Laws ER Jr (2001) The Surgical Management of Pituitary adenomas in a series of 3,093 patients. J Am Coll Surg 193(6):651\u2013659. https:\/\/doi.org\/10.1016\/s1072-7515(01)01101-2","journal-title":"J Am Coll Surg"},{"key":"1483_CR11","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/1477-7819-12-94","volume":"12","author":"Y Gao","year":"2014","unstructured":"Gao Y, Zhong C, Wang Y et al (2014) Endoscopic Versus Microscopic Transsphenoidal Pituitary Adenoma surgery: a Meta-analysis. World J Surg Oncol 12:94. https:\/\/doi.org\/10.1186\/1477-7819-12-94","journal-title":"World J Surg Oncol"},{"issue":"6","key":"1483_CR12","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1177\/19458924231193527","volume":"37","author":"V Vasan","year":"2023","unstructured":"Vasan V, Dullea JT, Devarajan A et al (2023) Predictors of prolonged length of Stay after Pituitary Adenoma Resection: a large cohort analysis using the National Inpatient Sample (2016\u20132019). Am J Rhinol Allergy 37(6):758\u2013765. https:\/\/doi.org\/10.1177\/19458924231193527","journal-title":"Am J Rhinol Allergy"},{"issue":"19","key":"1483_CR13","doi-asserted-by":"publisher","first-page":"n","DOI":"10.3390\/jcm11195829","volume":"11","author":"M Saad","year":"2022","unstructured":"Saad M, Salze B, Trillat B et al (2022) Association between Preoperative Medication Lists and postoperative hospital length of stay after endoscopic transsphenoidal pituitary surgery. J Clin Med 11(19):n. https:\/\/doi.org\/10.3390\/jcm11195829","journal-title":"J Clin Med"},{"issue":"2","key":"1483_CR14","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1227\/neu.0000000000002890","volume":"95","author":"A Devarajan","year":"2024","unstructured":"Devarajan A, Vasan V, Dullea JT et al (2024) Clinical and operative risk factors Associated with prolonged length of Stay after Endoscopic Pituitary Adenoma Resection. Neurosurgery 95(2):392\u2013399. https:\/\/doi.org\/10.1227\/neu.0000000000002890","journal-title":"Neurosurgery"},{"issue":"4","key":"1483_CR15","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1177\/0194599816652379","volume":"155","author":"AM Bur","year":"2016","unstructured":"Bur AM, Brant JA, Newman JG et al (2016) Incidence and risk factors for prolonged hospitalization and readmission after transsphenoidal pituitary surgery. Otolaryngol Head Neck Surg 155(4):688\u2013694. https:\/\/doi.org\/10.1177\/0194599816652379","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"6","key":"1483_CR16","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1002\/alr.22540","volume":"10","author":"S Vimawala","year":"2020","unstructured":"Vimawala S, Chitguppi C, Reilly E et al (2020) Predicting prolonged length of stay after endoscopic transsphenoidal surgery for Pituitary Adenoma. Int Forum Allergy Rhinol 10(6):785\u2013790. https:\/\/doi.org\/10.1002\/alr.22540","journal-title":"Int Forum Allergy Rhinol"},{"key":"1483_CR17","doi-asserted-by":"publisher","first-page":"100259","DOI":"10.1016\/j.wnsx.2023.100259","volume":"21","author":"S Varela","year":"2024","unstructured":"Varela S, Thommen R, Rumalla K et al (2024) The risk analysis Index demonstrates Superior discriminative ability in Predicting extended length of stay in Pituitary Adenoma Resection patients when compared to the 5-point modified Frailty Index. World Neurosurg X 21:100259. https:\/\/doi.org\/10.1016\/j.wnsx.2023.100259","journal-title":"World Neurosurg X"},{"issue":"3","key":"1483_CR18","doi-asserted-by":"publisher","first-page":"e66","DOI":"10.37765\/ajmc.2021.88600","volume":"27","author":"C Ward","year":"2021","unstructured":"Ward C, Patel V, Elsaid MI, Jaisinghani P, Sharma R (2021) A case-control study of length of Stay outliers. Am J Manag Care 27(3):e66\u2013e71. https:\/\/doi.org\/10.37765\/ajmc.2021.88600","journal-title":"Am J Manag Care"},{"key":"1483_CR19","doi-asserted-by":"publisher","first-page":"e357","DOI":"10.1016\/j.wneu.2023.01.028","volume":"172","author":"SP Miranda","year":"2023","unstructured":"Miranda SP, Blue R, Parasher AK et al (2023) Implementation of a Streamlined Care Pathway to reduce cost and length of stay for patients undergoing endoscopic transsphenoidal pituitary surgery. World Neurosurg 172:e357\u2013e363. https:\/\/doi.org\/10.1016\/j.wneu.2023.01.028","journal-title":"World Neurosurg"},{"key":"1483_CR20","doi-asserted-by":"publisher","first-page":"e670","DOI":"10.1016\/j.wneu.2018.09.187","volume":"121","author":"SH Chen","year":"2019","unstructured":"Chen SH, Sprau A, Chieng L et al (2019) Transsphenoidal Approach for Pituitary adenomas in Elderly patients. World Neurosurg 121:e670\u2013e674. https:\/\/doi.org\/10.1016\/j.wneu.2018.09.187","journal-title":"World Neurosurg"},{"issue":"6","key":"1483_CR21","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1055\/a-1920-0758","volume":"83","author":"MK Ghiam","year":"2022","unstructured":"Ghiam MK, Ali IA, Dable CL et al (2022) Multidisciplinary postoperative care pathway to reduce readmissions following endoscopic transsphenoidal pituitary surgery: improving Quality of Patient Care. J Neurol Surg B Skull Base 83(6):626\u2013634. https:\/\/doi.org\/10.1055\/a-1920-0758","journal-title":"J Neurol Surg B Skull Base"},{"issue":"4","key":"1483_CR22","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1227\/00006123-199310000-00008","volume":"33","author":"E Knosp","year":"1993","unstructured":"Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary Adenomas with Invasion of the cavernous Sinus Space: a magnetic resonance imaging classification compared with Surgical findings. Neurosurgery 33(4):610\u2013617 discussion 617\u2013618. https:\/\/doi.org\/10.1227\/00006123-199310000-00008","journal-title":"Neurosurgery"},{"issue":"18","key":"1483_CR23","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1056\/NEJMsa063682","volume":"355","author":"MB Rosenthal","year":"2006","unstructured":"Rosenthal MB, Landon BE, Normand SL, Frank RG, Epstein AM (2006) Pay for performance in commercial HMOs. N Engl J Med 355(18):1895\u20131902. https:\/\/doi.org\/10.1056\/NEJMsa063682","journal-title":"N Engl J Med"},{"issue":"9","key":"1483_CR24","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1377\/hlthaff.2010.0394","volume":"30","author":"N Sood","year":"2011","unstructured":"Sood N, Huckfeldt PJ, Escarce JJ, Grabowski DC, Newhouse JP (2011) Medicare\u2019s Bundled Payment Pilot for Acute and Postacute Care: analysis and recommendations on where to begin. Health Aff (Millwood) 30(9):1708\u20131717. https:\/\/doi.org\/10.1377\/hlthaff.2010.0394","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"1483_CR25","first-page":"489","volume":"42","author":"JW Thomas","year":"1997","unstructured":"Thomas JW, Guire KE, Horvat GG (1997) Is patient length of Stay related to quality of care? Hosp Health Serv Adm 42(4):489\u2013507","journal-title":"Hosp Health Serv Adm"},{"issue":"3\u20134","key":"1483_CR26","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/j.wneu.2013.11.014","volume":"81","author":"JG Thomas","year":"2014","unstructured":"Thomas JG, Gadgil N, Samson SL, Takashima M, Yoshor D (2014) Prospective trial of a short Hospital Stay Protocol after endoscopic endonasal pituitary adenoma surgery. World Neurosurg 81(3\u20134):576\u2013583. https:\/\/doi.org\/10.1016\/j.wneu.2013.11.014","journal-title":"World Neurosurg"},{"key":"1483_CR27","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.wneu.2024.03.135","volume":"186","author":"H Shah","year":"2024","unstructured":"Shah H, Slavin A, Botvinov J, O\u2019Malley GR Jr, Sarwar S, Patel NV (2024) Endoscopic endonasal transsphenoidal surgery for the resection of Pituitary adenomas: a Prime candidate for a shortened length of Stay enhanced recovery after surgery protocol? A systematic review. World Neurosurg 186:145\u2013154. https:\/\/doi.org\/10.1016\/j.wneu.2024.03.135","journal-title":"World Neurosurg"},{"issue":"6","key":"1483_CR28","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1007\/s11102-020-01069-5","volume":"23","author":"AM Khalafallah","year":"2020","unstructured":"Khalafallah AM, Shah PP, Huq S et al (2020) The 5-factor modified Frailty Index predicts Health Burden following surgery for Pituitary Adenomas. Pituitary 23(6):630\u2013640. https:\/\/doi.org\/10.1007\/s11102-020-01069-5","journal-title":"Pituitary"},{"key":"1483_CR29","doi-asserted-by":"publisher","unstructured":"Dasenbrock HH, Liu KX, Devine CA et al (2015) Length of Hospital stay after craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis. Neurosurg Focus 39(6). https:\/\/doi.org\/10.3171\/2015.10.Focus15386","DOI":"10.3171\/2015.10.Focus15386"},{"issue":"2","key":"1483_CR30","doi-asserted-by":"publisher","first-page":"360","DOI":"10.3171\/2018.8.jns181875","volume":"132","author":"AO Asemota","year":"2019","unstructured":"Asemota AO, Gallia GL (2019) Impact of frailty on short-term outcomes in patients undergoing transsphenoidal pituitary surgery. J Neurosurg 132(2):360\u2013370. https:\/\/doi.org\/10.3171\/2018.8.jns181875","journal-title":"J Neurosurg"},{"issue":"6","key":"1483_CR31","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.3171\/2019.1.Jns182394","volume":"132","author":"N Mouchtouris","year":"2020","unstructured":"Mouchtouris N, Lang MJ, Barkley K et al (2020) Predictors of Hospital-Associated complications prolonging ICU stay in patients with low-Grade Aneurysmal Subarachnoid Hemorrhage. J Neurosurg 132(6):1829\u20131835. https:\/\/doi.org\/10.3171\/2019.1.Jns182394","journal-title":"J Neurosurg"}],"container-title":["Pituitary"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11102-024-01483-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11102-024-01483-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11102-024-01483-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T14:33:33Z","timestamp":1741444413000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11102-024-01483-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,25]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["1483"],"URL":"https:\/\/doi.org\/10.1007\/s11102-024-01483-z","relation":{},"ISSN":["1386-341X","1573-7403"],"issn-type":[{"value":"1386-341X","type":"print"},{"value":"1573-7403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,25]]},"assertion":[{"value":"2 November 2024","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 January 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"None.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}],"article-number":"21"}}