30 Day Metrics Following Endoscopic Expanded Endonasal Approach for Pituitary Adenomas

 

Introduction: The endoscopic expanded endonasal approach is becoming the standard approach to the sella for resection of pituitary adenomas and other sellar and suprasellar pathologies. This approach allows reduced morbidity during the surgical approach, with significant improvements in visualization. The purpose of this study is to analyze patient characteristics, comorbidities, length of stay and 30 days major complication rates in patients undergoing endoscopic expanded endonasal approach for pituitary adenoma resection by a single team at an academic center.

Methods: A retrospective analysis of 337 consecutive cases of patient undergoing an endoscopic expanded endonasal approach for pituitary adenoma resection from March 1, 2011 to March 1, 2016 was performed. Traditional speculum transsphenoidal approaches were not included. Operative data, demographics, comorbidities, length of stay, readmission rates, ED visits and complications rates were collected using the electronic medical record. Patients were initially stratified by those having secretory versus non-secretory tumors. Secretory tumors were further analyzed by tumor type. The primary endpoints were 30 day surgical complication rates and hospital length of stay.

Results: There were 337 patients in our cohort. Of those patients, 60.5% (204/337) had non-secretory macroadenomas and 39.5% (133/337) were secretory tumors. Of the secreting tumors, 57.1% (76/133) of patients presented with acromegaly, 30.1% (41/133) of patients presented with Cushing’s disease, 10.5% (14/133) of patients had prolactinomas unresponsive to medical management and 1.5% (2/133) of patients had thyrotropinomas. Patients with non-secreting tumors were more likely to be older (58.2 vs. 46.2 years, p < 0.001), male (62.7 vs. 44.4%, p < 0.001), and have a lower BMI (31.7 vs. 33.8, p = 0.001). There were no differences in other comorbidities between the two groups. Patients with non-secretory macroadenomas had shorter overall hospital stays (2.72 vs. 3.48 days, p = 0.048) when compared with patients with secretory tumors. When broken down by tumor type, patients with Cushing’s disease had longer hospitals stays than patients with macroadenomas (5.46 versus 2.72 days, p < 0.001) and acromegaly (5.46 vs. 2.42 days, p < 0.001). There were no statistically significant differences between length of stay for patients with non-secreting tumors, acromegaly, or prolactinomas. Post-operative complications were similar among the groups, with the exception of patients with Cushing’s disease having a higher risk of DVT/PE compared with all other patients (9.8% versus 0.7%, p = 0.002) and a higher 30 day mortality rate (4.9% versus 0.3%, p = 0.004).

Conclusion: There is minimal morbidity following endoscopic expanded endonasal approach for pituitary adenoma resection and patients can be safely discharged home 2–3 days post-operatively. Patients with Cushing’s disease, however, often require longer hospital stays and have a statistically significantly higher risk of DVT/PE and 30 day mortality.