Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery.

Autor: Boling CC; Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC., Karnezis TT; Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC., Baker AB; Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC., Lawrence LA; Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC., Soler ZM; Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC., Vandergrift WA 3rd; Department of Neurosurgery, Medical University of South Carolina, Charleston, SC., Wise SK; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA., DelGaudio JM; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA., Patel ZM; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA., Rereddy SK; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA., Lee JM; Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada., Khan MN; Icahn School of Medicine at Mount Sinai, New York, NY., Govindaraj S; Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY., Chan C; Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia., Oue S; Department of Otolaryngology-Head and Neck Surgery, Modbury Hospital, Adelaide, Australia., Psaltis AJ; University of Adelaide, Adelaide, Australia., Wormald PJ; Department of Otolaryngology-Head and Neck Surgery, The University of Adelaide, Australia., Trosman S; Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Stokken J; Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Woodard T; Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Sindwani R; Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH., Schlosser RJ; Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
Jazyk: angličtina
Zdroj: International forum of allergy & rhinology [Int Forum Allergy Rhinol] 2016 Jan; Vol. 6 (1), pp. 101-7. Date of Electronic Publication: 2015 Aug 06.
DOI: 10.1002/alr.21622
Abstrakt: Background: The goal of this study was to identify preoperative risk factors associated with increased perioperative morbidity after endoscopic pituitary surgery.
Methods: A retrospective review of patients undergoing endoscopic pituitary adenoma surgery between 2002 and 2014 at 6 international centers was performed. Standard demographic and comorbidity data, as well as information regarding tumor extent and treatment were collected. Logistic regression was used to examine risk factors for the following 30-day outcomes: systemic complications, intracranial complications, postoperative cerebrospinal fluid (CSF) leaks, length of hospital stay, readmission, and reoperation.
Results: Data was collected on 982 patients with a mean age of 52 years. The median body mass index (BMI) for all patients was 30.9 kg/m(2) with 56% female. The median hospital stay was 5 days and 23.8% of patients suffered a postoperative adverse event. Systemic complications occurred in 3.2% of patients and intraventricular extension was a risk factor (odds ratio [OR] 8.9). Intracranial complications occurred in 7.3% of patients and risk factors included previous radiation (OR 8.6) and intraventricular extension (OR 7.9). Reoperation occurred in 6.5% of patients and intraventricular extension (OR 7.3) and age (<40 years, OR 3.5; 40 to 64 years, OR 3.2) were risk factors. Postoperative CSF leaks occurred in 5.5% of patients and risk factors included female gender (OR 2.4), BMI ≥ 30 (OR 2.1), age (<40 years, OR 5.3; 40 to 64 years, OR, 7.9), and intraventricular extension (OR, 9.5).
Conclusion: Postoperative endoscopic pituitary adenoma surgery complications are associated with tumors with intraventricular extension, preoperative radiation, as well as common patient comorbidities. Identification of these factors may permit implementation of strategies to reduce postoperative complications.
(© 2015 ARS-AAOA, LLC.)
Databáze: MEDLINE
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