Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Abstract

Objective: Transsphenoidal surgery (TSS) harbors a potential for hypopituitarism, cerebrospinal fluid (CSF) leaks, and other complications. We utilized the Nationwide Inpatient Sample Database (NIS) to compare inpatient complication rates between Cushing's disease (CD) and non-Cushing's disease (NCD) patients undergoing TSS. Methods: Inpatient hospitalization data for 960 CD and 12 110 NCD patients who underwent TSS between 2002 and 2010 were accessed. Demographic information, outcomes, and complication rates were evaluated. Results: Patients with CD had a female predilection (81.7%) and were younger (40.5 ± 14.4 years) than NCD patients (47.8% female; 52.1 ± 16.3 years) (P < .001). Length of stay and total charges did not differ between groups. Patients with CD had significantly greater postoperative diabetes insipidus rates (14.0% vs 9.6%, P < .001) and urinary/renal complications (1.7% vs 0.9%, P = .027). After adjusting for possible confounders, the relationship between urinary/renal complications and CD status strengthened. There was no difference in rates of CSF leak and iatrogenic pituitary disorders overall. Conclusion: No differences were noted in the rate of early CSF leaks between postoperative TSS CD and NCD patients. Postoperative diabetes insipidus did not significantly differ between groups after adjusting for confounders. Only odds of urinary/renal complications in CD patients was significant after adjustment.

Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?

“…In our sample consisting of over 10,000 patients treated in the most recent year available with NIS inpatient data, we identified an overall postoperative CSF rhinorrhea incidence of 2.6%. Despite numerous surgical advancements to address postoperative CSF leaks, including the utilization of endoscopic techniques pioneered by Wigand in 1981, our data coincide with the likes of many previously published samples characterizing extended hospital stays, additional procedures, additional anesthesia risks, and higher discharge total costs associated with this complication . Jahangiri et al reported in 2014 that repeat operations for recurring tumors or postoperative CSF leak can carry an increased risk for electrolyte abnormalities including hyponatremia and meningitis, both significantly adding to morbidity and an increased length of hospitalization .…”

“…Numerous analyses characterize a link between obesity and postoperative CSF rhinorrhea following procedures on the pituitary . Dlouhy et al demonstrated that an increase in one's body mass index (BMI) of 5 kg/m 2 increased the risk of postoperative CSF rhinorrhea by 1.61 times .…”

“…The incidence of postoperative CSF rhinorrhea following pituitary surgery varies by study, with most analyses reporting this rate to be between 0.7% and 12% . Existing reports largely characterize the subsequent inpatient hospitalization of patients following pituitary surgery for a specific disease presentation or offer a comparative analysis of surgical outcomes between comorbid and noncomorbid patients.…”

Impact of obstructive sleep apnea in transsphenoidal pituitary surgery: An analysis of inpatient data

“…TSS complications have been previously characterized in various patient populations, such as those with acromegaly, Cushing's disease, and pituitary malignancies . However, the impact of obstructive sleep apnea (OSA) on TSS outcomes is a relevant concern that has not been well examined.…”

“…[2][3][4] TSS complications have been previously characterized in various patient populations, such as those with acromegaly, Cushing's disease, and pituitary malignancies. [5][6][7] However, the impact of obstructive sleep apnea (OSA) on TSS outcomes is a relevant concern that has not been well examined. OSA is a sleeping disorder characterized by upper airway collapse, with an incidence of 3% to 7% in the general population.…”