Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients
| Autor: | Jai Deep Thakur, Howard R. Krauss, Amalia Eisenberg, Daniel F. Kelly, Sarah Rettinger, Alex Corlin, Garni Barkhoudarian, Samantha Yawitz, Regin Jay Mallari, Pejman Cohan, Chester Griffiths, Walavan Sivakumar, Ricardo L. Carrau, Katherine A. Araque |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adenoma
Adult medicine.medical_specialty Endocrinology Diabetes and Metabolism Anosmia 030209 endocrinology & metabolism Hypopituitarism Article 03 medical and health sciences 0302 clinical medicine Endocrinology Postoperative Complications Pituitary adenoma medicine.artery Medicine Humans Prolactinoma Pituitary Neoplasms Endoscopic endonasal Stroke Aged Retrospective Studies business.industry Endoscopy Cushing's disease Cushing’s disease Hospital readmission Middle Aged medicine.disease Surgery Treatment Outcome Acromegaly Length of stay Internal carotid artery medicine.symptom business Complication 030217 neurology & neurosurgery |
| Zdroj: | Pituitary |
| ISSN: | 1573-7403 1386-341X |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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