Geographic and Socioeconomic Predictors of Early Follow-Up Loss in Patients Undergoing Pituitary Neuroendocrine Tumors (PitNETs) Resection: A Retrospective Review of 1143 Cases.

Abstract

Postoperative follow-up after pituitary neuroendocrine tumor (PitNET) resection is essential for monitoring tumor recurrence and endocrinologic deficits. Despite advances in telehealth, loss to follow-up remains a persistent challenge across neurosurgical patients. This study aims to identify factors to identify patients are at higher risk of being lost to follow-up after surgery. A retrospective analysis was conducted on 1143 adult patients who underwent PitNET resection between 2012 and 2019 at a single institution. Clinical and radiological data were analyzed to assess loss to follow-up in the cohort. Multivariable logistic and negative binomial regression models were used to identify factors independently associated with follow-up loss. Of the 1143 patients included, 131 (11.5%) were lost to follow-up within 3 months after surgery. Compared to those with longer follow-up, these patients were younger (median 44.0 vs. 51.0 years, P=0.032), lived farther from the medical center (515.5 vs. 309.7 km, P=0.024), experienced longer delays to surgery (148 vs. 104 days, P=0.027), and had smaller tumors (1.54 vs. 1.74 cm, P=0.04). Multivariable analysis identified uninsured status (odds ratio 3.43, 95% confidence interval 1.14-10.33, P=0.02) and greater distance to care (odds ratio 1.01, 95% confidence interval 1.00-1.01, P=0.03) as independent predictors of early follow-up loss. To follow-up after PitNET surgery remains a substantial concern, particularly among younger, uninsured patients and those residing farther from the treating center. These findings highlight the importance of early identification and proactive outreach to high-risk individuals.