Low preoperative serum prealbumin levels and risk of postoperative complications after transsphenoidal surgery in nonfunctioning pituitary adenoma

Shuaihua Song; Peng Qiu; Haoran Wang; Di Zhang; Qianjin Qi; Li Feng

doi:10.3171/2022.9.FOCUS22211

Low preoperative serum prealbumin levels and risk of postoperative complications after transsphenoidal surgery in nonfunctioning pituitary adenoma

Neurosurg Focus. 2022 Dec;53(6):E6. doi: 10.3171/2022.9.FOCUS22211.

Authors

Shuaihua Song¹, Peng Qiu², Haoran Wang³, Di Zhang¹, Qianjin Qi¹, Li Feng⁴

Affiliations

¹ 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong.
² 2Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong.
³ 3Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong; and.
⁴ 4Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.

PMID: 36455266
DOI: 10.3171/2022.9.FOCUS22211

Abstract

Objective: In other specialties, malnutrition has been shown to be closely linked to postoperative complications. However, there is no research on the relationship between nutritional parameters and the complications of transsphenoidal pituitary surgery. This study was designed to identify the relationship between preoperative nutritional markers and postoperative complications in nonfunctioning pituitary adenomas.

Methods: This observational study included 429 patients whose first transsphenoidal surgery was performed in Shandong Provincial Hospital between January 2015 and July 2020. Preoperative prealbumin, retinol-binding protein (RBP), the prognostic nutritional index, clinicopathological data, and postoperative complication data were collected to investigate outcomes.

Results: After multivariable adjustment, preoperative prealbumin and RBP were inversely associated with risk of complication (p value for trend = 0.006, 0.021). The increase of preoperative serum prealbumin and RBP concentration may decrease the risk of postoperative intracranial infection and hyponatremia (both OR per SD increment, < 1; p < 0.05). The increase of preoperative prealbumin may also decrease the risk of diabetes insipidus (OR per SD increment, 0.591; p = 0.001), but similar results were not obtained for the RBP (p > 0.05). Prealbumin and RBP are both useful in predicting overall complications (area under the receiver operating characteristic curve [AUC] 0.749, 0.678), especially in intracranial infection (AUC 0.794, 0.738). However, the predictive value of prealbumin was better than that of RBP.

Conclusions: Low preoperative prealbumin or RBP concentrations may be associated with higher surgical risk, especially for intracranial infection. This study emphasizes the suggestion that preoperative prealbumin and RBP concentrations may be vital factors in predicting operative complications of nonfunctioning pituitary adenomas.

Keywords: complications; intracranial infection; nonfunctioning adenoma; prealbumin; retinol-binding protein; transsphenoidal surgery.

Publication types

Observational Study

MeSH terms

Humans
Pituitary Neoplasms* / surgery
Postoperative Complications / etiology
Prealbumin
ROC Curve

Substances

Prealbumin