Prediction of Readmission and Complications After Pituitary Adenoma Resection via the National Surgical Quality Improvement Program (NSQIP) Database

Abstract

IntroductionPituitary adenomas are common intracranial tumors (incidence 4:100,000 people) with good surgical outcomes; however, a subset of patients show higher rates of perioperative morbidity. Our goal was to identify risk factors for postoperative complications or readmission after pituitary adenoma resection. MethodsWe undertook a retrospective cohort study of patients who underwent surgery for pituitary adenoma in 2006-2018 by using the National Surgical Quality Improvement Program database. The main outcome measures were patient complications and the 30-day readmission rate. ResultsAmong the 2,292 patients (mean age 53.3±15.9 years), there were 491 complications in 188 patients (8.2%). Complications and 30-day readmission have remained stable over time rather than declined. Unplanned readmission was seen in 141 patients (6.2%). Multivariable analysis demonstrated that hypertension (OR=1.6; 95% CI= 1.1, 2.1; p=0.005) and high white blood cell count (OR=1.08; 95% CI=1.03, 1.1; p=0.0001) were independent predictors of complications. Return to the operating room (OR=5.9, 95% CI=1.7, 20.2, p=0.0005); complications (OR=4.1, 95% CI=1.6, 10.6, p=0.004); and blood urea nitrogen (OR=1.08, 95% CI=1.02, 1.2, p=0.02) were independent predictors of 30-day readmission. ConclusionUsing one of the largest datasets of pituitary adenoma patients, we identified perioperative factors most critical for patient outcome. One strength of this study is adjusting for cofactors that predict outcomes, which has not been done previously. Several patient biomarkers, namely white blood cell count and blood urea nitrogen, may serve as preoperative markers that might identify patients at higher risk. Control of blood pressure and renal disease may be perioperative management strategies that can impact the outcome.

Endoscopic Reconstruction of the Sellar Floor by Extended Inferior Turbinate Flap in Recurrent Pituitary Tumors

“…cleft. 13,14 The endoscopic endonasal surgical approaches have become the primary surgical technique to address sellar tumors. This is due to their advantages of better visualization, permitting a panoramic view of tissues and their surrounding vascular structures, with improved safety and efficacy.…”

“…cleft (13,14) . The endoscopic endonasal surgical approaches have become the primary surgical technique to address sellar tumors.…”

Machine Learning–Based Analysis and Prediction of Unplanned 30-Day Readmissions After Pituitary Adenoma Resection: A Multi-Institutional Retrospective Study With External Validation

“…Traditional statistical methods have associated adverse events after transsphenoidal surgery with length of hospital stay, ASA classification, age, operation time, and tumor size, 1,2,20,21 but they have failed to identify any clear predictors of unplanned 30-day readmissions or to stratify patients into risk categories. 1,22-26 Furthermore, most studies included readmission data from only a single institution, used a singular statistical technique (eg, regression analysis), focused on readmissions for a specific reason (eg, hyponatremia), or did not validate their predictive model.…”

“…Traditional statistical methods have associated adverse events after transsphenoidal surgery with length of hospital stay, ASA classification, age, operation time, and tumor size, 1,2,20,21 but they have failed to identify any clear predictors of unplanned 30day readmissions or to stratify patients into risk categories. 1,[22][23][24][25][26]…”

Anterior Skull Base Outcomes and Complications: A Propensity Score–Matched Evaluation of Age and Frailty as Measured by mFI-5 from the ACS-NSQIP Database

“…[6][7][8][9][10] Previously proposed risk factors of complications after endoscopic skull base surgery include advanced age, size, history of prior surgery, preoperative radiation, elevated intracranial pressure, body mass index (BMI), blood urea nitrogen, and white blood cell counts. 1,11,12 Age-dependent differences in these factors yield unique patient risk profiles. 7,9 Identifying comprehensive, user-friendly metrics to predict postoperative outcomes will help neurosurgeons develop surgical treatment plans, improve outcomes, and optimize patient selection before surgical procedures.…”