Regional disparities and practice patterns in surgical approaches to pituitary tumors in the United States

Background: Traditional microscopic and endoscopic transsphenoidal approaches (TSAs) are the most common surgical techniques in pituitary surgery. Examining regional practice patterns in pituitary surgery can provide valuable insights into which surgical strategies are most accessible, effective, and cost-efficient. In this study we investigated regional variations in surgical approaches to pituitary tumors and evaluated evolving practice patterns in pituitary surgery.

Methods: The 2010 Medicare Part B Carrier Summary Database and Medicare Part B National Summary Database from 2003-2010 were examined using pituitary surgery Current Procedure Terminology (CPT) codes 61548 (microscopic transsphenoidal approach), 62165 (endoscopic transsphenoidal approach), and 61546 (transcranial approach).

Results: Endoscopic TSAs increased by over 10-fold in the past decade, while usage of microscopic TSAs decreased by 23.3%. Nevertheless, the microscopic approach was still the most common TSA (64.7%) in 2010 compared to the endoscopic approach (35.3%). The microscopic TSA was predominant in the Southern and Western United States (74% and 69%, respectively). In the Northeast and Midwest, the rates of microscopic and endoscopic TSAs were roughly equivalent. However, the rate of endoscopic TSAs was statistically significantly higher (p < 0.05) in the Northeast and Midwest (47% and 45%, respectively) than in the South and West (26% and 31%, respectively). Transcranial approaches continued to decline from 4% to 2% over the last decade.

Conclusion: Regional disparities in transsphenoidal practice patterns exist in the United States. Although the microscopic approach is still more common overall, there has been an evolving shift toward endoscopic TSAs in the last decade.