Clinical and Operative Risk Factors Associated With Prolonged Length of Stay After Endoscopic Pituitary Adenoma Resection

Alex Devarajan; Vikram Vasan; Jonathan T Dullea; Jack Y Zhang; Devarshi Vasa; Alexander J Schupper; Noah Nichols; Daniel Ranti; Lily McCarthy; Manasa Rao; Sweta Sudhir; Logan Cho; John W Rutland; Kalmon D Post; Joshua Bederson; Raj K Shrivastava

doi:10.1227/neu.0000000000002890

Clinical and Operative Risk Factors Associated With Prolonged Length of Stay After Endoscopic Pituitary Adenoma Resection

Neurosurgery. 2024 Feb 29. doi: 10.1227/neu.0000000000002890. Online ahead of print.

Authors

Alex Devarajan¹, Vikram Vasan, Jonathan T Dullea, Jack Y Zhang, Devarshi Vasa, Alexander J Schupper, Noah Nichols, Daniel Ranti, Lily McCarthy, Manasa Rao, Sweta Sudhir, Logan Cho, John W Rutland, Kalmon D Post, Joshua Bederson, Raj K Shrivastava

Affiliation

¹ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

PMID: 38421190
DOI: 10.1227/neu.0000000000002890

Abstract

Background and objectives: Pituitary adenomas (PAs) are the most common intrasellar tumor. Clinically relevant adenomas have a prevalence of 1 per 1000 in the general population. Transsphenoidal surgery (TSS) is the most common surgical treatment and is the first-line management for most PAs. Most patients fare well postoperatively, but a subset of patients experience a prolonged length of stay (PLOS). In this article, we aim to identify demographic and clinical factors associated with PLOS after TSS for PA.

Methods: Patients with sellar pathologies surgically treated at a single tertiary center from March 1, 2009, to May 31, 2020, were retrospectively reviewed. All patients older than 18 years receiving nonemergent endoscopic TSS for pituitary adenoma were included. Clinical and demographic characteristics were analyzed using χ2-tests and student t-tests. For those factors with a P-value less than .01, multivariate logistic regression and negative binomial regression models were constructed to estimate the adjusted odds of PLOS across predictive factors.

Results: A total of 301 patients were included in the study. This cohort had an average age of 54.65 ± 15.06 years and an average body mass index of 29.47 ± 6.69. The median length of stay was 54.9 hours [25th-75th percentiles: 43.5-72.9]. Postoperative cerebrospinal fluid leak (P < .01), postoperative diabetes insipidus (DI) (P < .01), increased surgery duration (P = .01), and elevated maximal tumor dimension (P = .01) were predictive of PLOS in logistic regression. Increased surgery duration, previous pituitary radiation, intraoperative complications, and postoperative DI (all P < .01) were associated with increased rate of PLOS in negative binomial regression.

Conclusion: Patients undergoing endoscopic TSS for PA resection demonstrate prolonged lengths of stay if they have higher tumor burden, have lengthier surgeries with intraoperative complications, or develop postoperative complications such as cerebrospinal fluid leak or DI. Careful monitoring of these factors will allow for better resource optimization, reducing costs to both the hospital and the patient.