Intraoperative MRI use in transsphenoidal surgery for pituitary tumors: Trends and healthcare utilization

Mayur Sharma; Dengzhi Wang; Victoria Scott; Beatrice Ugiliweneza; Kevin Potts; Jesse Savage; Maxwell Boakye; Norberto Andaluz; Brian J Williams

doi:10.1016/j.jocn.2023.03.009

Intraoperative MRI use in transsphenoidal surgery for pituitary tumors: Trends and healthcare utilization

J Clin Neurosci. 2023 May:111:86-90. doi: 10.1016/j.jocn.2023.03.009. Epub 2023 Mar 27.

Authors

Mayur Sharma¹, Dengzhi Wang², Victoria Scott², Beatrice Ugiliweneza², Kevin Potts³, Jesse Savage⁴, Maxwell Boakye², Norberto Andaluz⁵, Brian J Williams²

Affiliations

¹ Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, United States; Department of Neurosurgery, University of Minnesota, MMC 96, 420 Delaware St. SE, Minneapolis, MN 55455, United States. Electronic address: sharm983@umn.edu.
² Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY 40202, United States.
³ Department of Otorhinolaryngology, University of Louisville, Louisville, KY 40202, United States.
⁴ Department of Neurosurgery, Indiana University SOM, Indianapolis, IN 46202, United States.
⁵ Department of Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, United States.

PMID: 36989768
DOI: 10.1016/j.jocn.2023.03.009

Abstract

Background: Intraoperative magnetic resonance imaging (iMRI) use in transsphenoidal approach (TSA) for pituitary tumors (PTs) has been reported to improve the extent of resection (EOR). The aim of this study is to report the trends and the impact of iMRI on healthcare utilization in patients who underwent TSA for PTs.

Materials and methods: MarketScan database were queried using the ICD-9/10 and CPT-4, from 2004 to 2020. We included patients ≥ 18 years of age PTs with > 1 year follow-up. Outcomes were length of stay (LOS), discharge disposition, hospital/emergency room (ER) re-admissions, outpatient services, medication refills and corresponding payments.

Results: A cohort of 10,192 patients were identified from the database, of these 141 patients (1.4%) had iMRI used during the procedure. Use of iMRI for PTs remained stable (2004-2007: 0.85%; 2008-2011: 1.6%; 2012-2015:1.4% and 2016-2019: 1.46%). No differences in LOS (median 3 days each), discharge to home (93% vs. 94%), complication rates (7% vs. 13%) and payments ($34604 vs. $33050) at index hospitalization were noted. Post-discharge payments were not significantly different without and with iMRI use at 6-months ($8315 vs. $ 7577, p = 0.7) and 1-year ($13,654 vs. $ 14,054, p = 0.70), following the index procedure.

Conclusion: iMRI use during TSA for PTs remained stable with no impact on LOS, complications, discharge disposition and index payments. Also, there was no difference in combined index payments at 6-months, and 1-year after the index procedure in patients with and without iMRI use for PTs.

Keywords: Healthcare utilization; Intraoperative MRI; National database; Pituitary tumor; Surgery.

MeSH terms

Adenoma* / surgery
Aftercare
Humans
Magnetic Resonance Imaging / methods
Patient Acceptance of Health Care
Patient Discharge
Pituitary Neoplasms* / diagnostic imaging
Pituitary Neoplasms* / pathology
Pituitary Neoplasms* / surgery
Retrospective Studies