(1212) Associations of Insurance Status, Frailty, and American Society of Anesthesiologists in Endoscopic Transnasal Transsphenoidal Surgery

Introduction: Socioeconomic risks factors for transnasal transsphenoidal (TNTS) surgery are poorly understood. We aim to investigate the effect of insurance status, frailty, and American Society of Anesthesiologists (ASA) score on preoperative presentation and postoperative outcomes in patients undergoing TNTS surgery.

Methods: Retrospective review of adult patients undergoing TNTS at a tertiary care center from 2014-2024. Independent variables included insurance status, modified frailty index (mFI)-5 score, and ASA score. Preoperative factors included vision change, pituitary apoplexy, and hormonal abnormality. Postoperative outcomes included cerebrospinal fluid (CSF) leak, vision changes, reoperation, hormonal disturbance, and mortality. Statistics were completed with Wilcoxon rank sum for discrete variables and Kruskal-Wallis for continuous variables.

Results: A total of 190 patients met inclusion criteria with median age 56 years, 51.1% female, and 17.3% non-white race. Median mFI-5 score was 1 and median ASA score was 3. Insurance type included private (n=101), Medicaid (n=9), Medicare (n=40), and uninsured (n=13). Preoperatively, 52 patients (27.4%) had hormonal abnormality and 13 (6.8%) had pituitary apoplexy. Preoperative factors were not associated with insurance status, frailty, or ASA. Neither insurance status nor frailty score were associated with postoperative complications. There was a positive association between ASA score and mortality (p-value=0.047). CSF leak was significantly positively associated with female sex and negatively associated with COPD, OSA, and cases of pituitary apoplexy.

Conclusions: Neither insurance status nor frailty score were associated with postoperative complications. There was a significantly positive association between mortality and ASA score. However, this finding may not be clinically significant given the population size. Insurance status, frailty, and ASA score were not significantly associated with preoperative factors. CSF leak was positively associated with female sex, although not associated with primary independent variables.