Factors Associated With a Higher 30-Day Hospitalization Period for Pituitary Adenoma Patients: Introducing a Novel Outcome Metric

BACKGROUND AND OBJECTIVES: A novel metric that incorporates both length of stay (LOS) and readmission in 1 metric, the 30-day hospitalization ratio (HR) (total number of days of hospitalization/30 days) was applied to patients undergoing endonasal surgery for pituitary adenoma. The objectives of this study were to determine predictive factors associated with prolonged hospitalization and economic burden and to demonstrate the utility of 30-day HR as a novel outcome metric compared with LOS and readmission. METHODS: A retrospective chart review of 492 patients who underwent an endoscopic endonasal approach for pituitary adenoma at a Pituitary Tumor Center of Excellence between January 2015 and September 2022. The main outcome measures analyzed were LOS, readmission, and HR. RESULTS: Patients had an average age of 55.4 ± 16.5 years; there were slightly more male patients (53.8%), and patients were predominantly White (82.5%). 49.2% of patients were employed, 6.2% were unemployed, 23.7% were retired, 5.3% were disabled, and 15.6% had unknown employment status. Intraoperative lumbar drain (LD) placement ( P = .003, 95% CI 1.77-16.39) and low preoperative prealbumin ( P = .01, 95% CI 1.17-7.33) were associated with readmission. Nonemployed status ( P = .004, β 2.93) and intraoperative LD placement ( P < .001, β 0.31) were associated with an increase in log LOS. Nonemployed status ( P < .001, β 0.18), intraoperative LD placement ( P < .001, β 0.33), and low preoperative prealbumin ( P = .04, β 0.14) were associated with a higher log HR. No nasoseptal flap reconstruction use was associated with decreased log LOS and log HR ( P = .002, β −0.16; P = .009, β −0.14). CONCLUSION: Hospitalization ratio is a noninferior metric to LOS and readmission and has the potential to provide a more complete quantification of outcomes and capture the impact of future hospital interventions.