{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T02:25:13Z","timestamp":1794018313900,"version":"4.8.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Socioeconomic disparities are increasingly recognized as contributors to variable healthcare outcomes, including hospital length of stay (LOS). This study investigates how social factors, including the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), influence postoperative LOS in patients undergoing endoscopic endonasal pituitary surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors retrospectively analyzed patients undergoing endoscopic transsphenoidal resection of pituitary adenoma or cyst at a single academic institution between January 2021 and December 2024. SVI scores and ADI percentiles were assigned based on ZIP codes. LOS comparisons across social variables were performed using Wilcoxon rank-sum, Pearson\u2019s chi-square, and Fisher\u2019s exact tests. Linear regression was used to assess the relationship between LOS, SVI, and ADI. Univariate and multivariable logistic regression were used to identify predictors of prolonged LOS (PLOS; &gt; 3 days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Overall, 158 patients (53% male, mean age 53 years) were included in this analysis, with a mean LOS of 4.58 days (SD 3.33 days). In the univariate analysis, female sex (p = 0.008), unemployment (p = 0.040), unmarried status (p = 0.016), lack of a primary care provider (p = 0.012), and an ADI &gt; 50th percentile (p = 0.014) were associated with PLOS. Postoperative diabetes insipidus showed a strong association with PLOS (p &lt; 0.001). Linear regression demonstrated that higher ADI percentiles (r = 0.211, p = 0.012) and larger tumors (r = 0.234, p = 0.005) predicted longer LOS. In the multivariable model, postoperative diabetes insipidus (OR 62.80, 95% CI 12.09\u2013510.67, p &lt; 0.001), unemployment (OR 9.00, 95% CI 2.06\u201350.54, p = 0.006), and unmarried status (OR 9.45, 95% CI 2.45\u201347.26, p = 0.003) independently predicted PLOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Social determinants of health, particularly a higher ADI percentile and unemployment, were associated with prolonged hospitalization following endoscopic pituitary surgery. These findings highlight the impact of social determinants on the postoperative course and surgical recovery. Increased understanding of these associations might enable interventions to reduce LOS and related healthcare costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.4.jns252634","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:01:14Z","timestamp":1791331274000},"page":"1-10","source":"Crossref","is-referenced-by-count":0,"title":["Social determinants of health and increased length of stay following endoscopic endonasal pituitary surgery"],"prefix":"10.3171","author":[{"given":"Anoop S.","family":"Chinthala","sequence":"first","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad A.","family":"Purcell","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Indiana University of School of Medicine, Indianapolis; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby T.","family":"Woodburn","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Pease","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satyan B.","family":"Sreenath","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Indiana University of School of Medicine, Indianapolis; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitesh V.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Paulo","family":"Almeida","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Endocrinol Metab Clin North Am","first-page":"347","article-title":"The epidemiology of pituitary adenomas","volume":"49","author":"Daly AF","year":"2020","unstructured":"Daly AF, Beckers A. The epidemiology of pituitary adenomas. Endocrinol Metab Clin North Am. 2020;49(3):347\u2013355. doi:10.1016\/j.ecl.2020.04.002"},{"issue":"145","key":"b2","series-title":"World Neurosurg","first-page":"154","article-title":"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","volume":"186","author":"Shah H","year":"2024","unstructured":"Shah H, Slavin A, Botvinov J, O\u2019Malley GR Jr, Sarwar S, Patel NV. 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. 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