Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients

Abstract

Purpose To evaluate the impact of using consistent complication-avoidance protocols in patients undergoing endoscopic pituitary adenoma surgery including techniques for avoiding anosmia, epistaxis, carotid artery injury, hypopituitarism, cerebrospinal fluid leaks and meningitis. Methods All patients undergoing endoscopic adenoma resection from 2010 to 2020 were included. Primary outcomes included 90-day complication rates, gland function outcomes, reoperations, readmissions and length of stay. Secondary outcomes were extent of resection, short-term endocrine remission, vision recovery. Results Of 514 patients, (mean age 51 ± 16 years; 78% macroadenomas, 19% prior surgery) major complications occurred in 18(3.5%) patients, most commonly CSF leak (9, 1.7%) and meningitis (4, 0.8%). In 14 of 18 patients, complications were deemed preventable. Four (0.8%) had complications with permanent sequelae (3 before 2016): one unexplained mortality, one stroke, one oculomotor nerve palsy, one oculoparesis. There were no internal carotid artery injuries, permanent visual worsening or permanent anosmia. New hypopituitarism occurred in 23/485(4.7%). Partial or complete hypopituitarism resolution occurred in 102/193(52.8%) patients. Median LOS was 2 days; 98.3% of patients were discharged home. Comparing 18 patients with major complications versus 496 without, median LOS was 7 versus 2 days, respectively p < 0.001. Readmissions occurred in 6%(31/535), mostly for hyponatremia (18/31). Gross total resection was achieved in 214/312(69%) endocrine-inactive adenomas; biochemical remission was achieved in 148/209(71%) endocrine-active adenomas. Visual field or acuity defects improved in 126/138(91.3%) patients. Conclusion This study suggests that conformance to established protocols for endoscopic pituitary surgery may minimize complications, re-admissions and LOS while enhancing the likelihood of preserving gland function, although there remains opportunity for further improvements.

Risk factors associated with complications and 30-day readmission in endoscopic endonasal transsphenoidal surgery: a single-institution retrospective analysis

“…Readmission within 30-days of discharge after EETS is an important topic due to patient care and cost considerations, especially with the recent trend towards rapid discharge after EETS. Several studies have commented on readmission rates and causes, with readmission occurring in 4.6-13.9% of patients, most commonly due to hyponatremia [20][21][22][23][24][25][26][27]. Our ndings are similar with 9.5% of all patients in our cohort requiring readmission within 30 days of surgery, and 34.5% of readmissions being secondary to hyponatremia.…”

Comparison of Endoscopic and Microscopic Transsphenoidal Approaches for the Resection of Pituitary Adenoma

“…However, our surgical complications were higher than the recent reports from experienced pituitary centers. (12,19) This could be related to the lower numbers of patients in our study and our less surgical experience. Nevertheless, the tumors in our series were slightly large, potentially causing complications, especially when GTR was attempted.…”

“…The rate of GTR in this study was comparable with the recent studies ranging from 57.6% to 95.4%. (11)(12)(13)(14). Although previous studies comparing surgical outcomes in ETSA and MTSA have shown inconsistent results, meta-analyses and systematic reviews in recent years have found generally favored ETSA.…”

The RAPID Consortium: A Platform for Clinical and Translational Pituitary Tumor Research

“…25 Simulation training can also help generate checklists for best practices (e.g., carotid injury on an endonasal procedure, management of cerebrospinal fluid leak). [26][27][28]…”

“…25 Simulation training can also help generate checklists for best practices (e.g., carotid injury on an endonasal procedure, management of cerebrospinal fluid leak). [26][27][28] Plans to continue expanding RAPID to other topics and institutional sites have been proposed. Additional topics will require involvement and agreement from different clinical sites.…”