Impact of insurance on outcomes of patients undergoing endoscopic transsphenoidal surgery for non-functional pituitary adenomas: a single institution study

Purpose: Uninsured and underinsured patients face notable healthcare disparities in neurosurgery, but limited literature exists on the impact of insurance on non-functioning pituitary adenomas (NFPAs). We investigated how insurance affects outcomes of endoscopic transsphenoidal pituitary surgery (ETPS) for NFPAs.

Methods: We retrospectively reviewed NFPA patients who underwent ETPS at our institution from 2012 to 2023. Patients were grouped by insurance status, and insured patients were further subcategorized by insurance providers. Bivariate analyses used Fisher's exact, chi-square, and t-tests. ANOVA or Kruskal-Wallis tests were applied for ≥ 2 groups. Logistic regression identified relationships between binomial variables and insurance.

Results: Our cohort (n = 651, 56.93 ± 15.53 years, 52.53% male) included 611 insured and 40 uninsured patients. Uninsured patients had lower preoperative KPS, higher rates of visual disturbances (VD), preoperative tumor volumes (TV), chiasm compression, and Knosp 4 grade, along with lower resection and longer hospital stays (LOS) (p < 0.05). Multivariate analysis showed lack of insurance was associated with increased VD (aOR 3.38), TV (aOR 2.63), Knosp 4 (aOR 3.44), subtotal resection (aOR 2.72), and prolonged LOS (aOR 7.03) (p < 0.05). When insured patients were grouped into Private (n = 361), Medicare (n = 223), and Medicaid (n = 23), Medicaid patients had larger preoperative TV, chiasm compression, Knosp 3 grade, and longer LOS (p < 0.05), with higher odds for Knosp 3 (aOR 3.00), subtotal resection (aOR 3.86), and prolonged LOS (aOR 8.38) (p < 0.05).

Conclusion: Our study highlights significant disparities in uninsured patients and those with Medicaid, underscoring the need for targeted interventions for these populations.