Association of non-English language preference with tumor characteristics and postoperative outcomes following pituitary neuroendocrine tumor resection:
a retrospective review of 1143 cases.

Abstract

Non-English language preference (NELP) poses a barrier to healthcare access and may contribute to delays in seeking care, understanding treatment plans, and communicating health concerns. This study assesses the relationship between NELP and the clinical characteristics and outcomes of patients with pituitary neuroendocrine tumors (PitNETs) at a high-volume tertiary center. A retrospective analysis was conducted on 1143 adult patients who underwent PitNET surgery between 2012 and 2019 at a single institution. Clinical and radiological variables were recorded for NELP patients and compared to patients with English language preference (ELP). Multivariable logistic and negative binomial regression analyses were used to assess associations between NELP, tumor characteristics, and postoperative outcomes, adjusting for confounders. Of the 1143 patients, 14.0% had NELP, with Spanish being the predominant language. NELP patients had larger tumor diameters (median [IQR] 2.0 [1.5-2.8] cm vs 1.5 [0.9-2.2] cm, p < 0.001) and higher rates of government insurance (78.2% vs 44.8%, p < 0.001), diagnosis during emergency department presentation (21.3% vs 7.5%, p < 0.001), cavernous sinus invasion (50.6% vs 30.7%, p < 0.001), and tumor apoplexy (8.8% vs 3.9%, p = 0.011), but they were less likely to present with preoperative endocrine disease (23.1% vs 41.6%, p < 0.001), and had shorter times to surgery (median [IQR] 79 [34.0-248.5] days vs 113 [53.0-430.8] days, p = 0.002) compared to ELP patients. NELP patients also had longer length of stay (LOS) (median [IQR] 2.00 [1.00-4.00] days vs 1.00 [1.00-2.00] days, p = 0.005) and higher lumbar drain placement rate (16.3% vs 8.1%, p = 0.002). In multivariable models, NELP was significantly associated with higher incidence rates of cavernous sinus invasion (OR 1.91, 95% CI 1.31-2.78, p < 0.001) and macroadenoma (OR 4.64, 95% CI 1.95-11.06, p < 0.001), prolonged LOS (incidence rate ratio 1.35, 95% CI 1.10-1.67, p = 0.004), and a lower rate of preoperative endocrine dysfunction (OR 0.56, 95% CI 0.35-0.92, p = 0.02), after adjustment for confounders. There were no significant differences in apoplexy at presentation, 30-day readmission rates, or lumbar drain use. NELP remained an independent risk factor for complex tumor presentation and extended hospital stay after controlling for sociodemographic factors. Understanding how NELP interacts with other health disparities in neurosurgical care can guide strategies to better support this patient population.