Predicting the Need for Desmopressin Treatment During Inpatient and After Discharge Following Endoscopic Sellar Surgery

Chia-En Wong; Wei-Hsin Wang; Ming-Ying Lan; Po-Hsuan Lee; Chi-Chen Huang; Pei-Fang Su; Jung-Shun Lee

doi:10.3389/fneur.2022.843646

Predicting the Need for Desmopressin Treatment During Inpatient and After Discharge Following Endoscopic Sellar Surgery

Front Neurol. 2022 Feb 17:13:843646. doi: 10.3389/fneur.2022.843646. eCollection 2022.

Authors

Chia-En Wong¹, Wei-Hsin Wang^{2

3}, Ming-Ying Lan^{3

4}, Po-Hsuan Lee¹, Chi-Chen Huang¹, Pei-Fang Su⁵, Jung-Shun Lee^{1

6

7}

Affiliations

¹ Section of Neurosurgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
² Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan.
³ School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
⁴ Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Department of Statistics, National Cheng Kung University, Tainan, Taiwan.
⁶ Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Abstract

Introduction: Postoperative diabetes insipidus (DI) is a common complication following endoscopic sellar surgery. However, the requirement of desmopressin treatment for patients with DI are heterogenous. Although the predictors of postoperative DI have been reported, whether these patients required desmopressin treatment remained uninvestigated. Predicting the need of desmopressin can benefit clinical decision making more directly than predicting the occurence of postoperative DI. This study aimed to identify variables that predict the need for desmopressin treatment following sellar surgery.

Methods: Patients undergoing endoscopic sellar surgery between 2016 and 2019 were retrospectively reviewed. Twenty-three variables, characterized as potential predictors for requiring desmopressin treatment, were analyzed. To assess the capability to generalize the identified predictors, external validation with receiver operating characteristic (ROC) analysis was performed using a second series from 2019 to 2020.

Results: Postoperative DI occurred in 40 of 159 included patients. Twelve patients required inpatient desmopressin treatment and 20 patients needed desmopressin prescription after discharge. The potential predictors of requiring any desmopressin use included higher peak sodium (Na) level (p = 0.007), lower minimum Na level (p = 0.043), and higher peak urine output (p = 0.006), but these were not supported by external validation. The predictors of requiring desmopressin after discharge included higher peak Na (p = 0.040) and minimum Na levels (p = 0.048), which were supported by external ROC validation showing areas under curve of 0.787, 0.611, and 0.898 for peak Na (p = 0.036), minimum Na (p = 0.460), and peak Na - minimum Na levels (p < 0.001), respectively. A criterion of peak Na ≥ 150 mmol/L or peak Na - minimum Na ≥ 10 predicted the need of desmopressin prescription after discharge. A postoperative management algorithm was proposed.

Conclusion: The required treatments for patients with postoperative DI following endoscopic sellar surgery are heterogenous. Elevated peak Na and large peak Na-minimum Na levels in the perioperative period predicted requiring desmopressin after hospital discharge. Patients with peak Na <150 mmol/L and peak Na-minimum Na <10 can be safely discharged without desmopressin prescription.

Keywords: desmopressin (DDAVP); diabetes insipidus; endoscopic endonasal approach (EEA); pituitary tumor; postoperative diabetes insipidus.