Abstract BACKGROUND Identifying which factors influence treatment costs of transsphenoidal surgery for removal of sellar lesions can be complex. OBJECTIVE To identify which patient-level factors are associated with higher costs and evaluate the relationship between expenditures and short-term patient-reported outcomes. METHODS We used an institutional database tool to review prospectively collected data on patients (≥10 yr old) undergoing transsphenoidal sellar surgery. Hospital costs, demographic data, disease-specific variables, hospital-related measures, and patient-reported outcomes (Euro-QOL 5D EQ-5D responses) were collected for all patients. RESULTS One hundred seventeen patients met the inclusion criteria. A multivariable logistic regression model for hospital costs showed a significant association between higher costs and adrenocorticotropic hormone-secreting tumors (odds ratio OR 86.34, 95% confidence interval CI 3.43-2176.42), larger tumor size (OR 1.13, 95% CI 1.01-1.28), and in-hospital complications (OR 14.98, 95% CI 2.21-101.68). The largest contributor to hospital costs in our cohort was facility cost (75%), followed by pharmacy (13%) and supply (7%) costs. Most patients (65.8%) had stable or improved EQ-5D responses at 1-mo follow-up. Stability or improvement in EQ-5D was more likely in patients with lower preoperative EQ-5D scores (P < .015) and with higher postoperative EQ-5D scores (P < .001) on univariate analysis. CONCLUSION Most patients undergoing transsphenoidal surgery for sellar tumors experience stable or improved postoperative quality of life, even shortly after surgery. Factors associated with increased costs of surgery included larger tumor size and in-hospital complications. Using these data, further study can be directed at determining which interventions may improve the value of transsphenoidal surgery.