Introduction: There is conflicting literature on what factors affect outcomes for patients undergoing pituitary surgery. We wished to determine what peri-operative factors are associated with adverse outcomes in patients undergoing transsphenoidal procedures for excision of benign pituitary tumors.
Methods: We identified 501 adult patients who underwent transsphenoidal excision of benign pituitary tumors from 2006-2012 at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a prospectively-collected, national clinical database with established reproducibility and validity. Univariate logistic regression identified baseline factors associated with adverse 30-day outcomes; all factors identified were incorporated into the final multivariate models.
Results: Mean age of patients was 54 ± 16 years; while 96% were admitted from home, 2.8% of surgeries were emergencies. Comorbidities were frequent. Median length of hospitalization (LOS) was 3 days; 50% of patients stayed between 2 and 4 days. Thirteen patients admitted from home were discharged with continued care; 37 patients experienced postoperative complications; there were 3 (0.6%) deaths. In multivariate modeling, duration of surgery, minority race (odd ratio [OR] = 1.9; 95% CI 1.2-3.1), ASA class >2 (2.0, 1.2-3.2), and emergency surgery (4.8, 1.1-20.5) collectively were strongly predictors for prolonged LOS; a resident in surgery (0.5, 0.3-0.8), a proxy for academic hospitals, was associated with better outcomes (C = 0.76). Advanced age and current smoking status (6.6, 1.7-25.0) were strong predictors for discharge with continued care (C = 0.80).
Conclusions: Commonly-available pre- and intraoperative factors are predictors of prolonged LOS and discharge destination, but not adverse outcomes in patients undergoing transsphenoidal excision of benign pituitary tumors. Given the cost and changing reimbursement patterns for LOS, it is important to identify and correct modifiable risk factors prior to surgery.
Patient Care: 1. It will allow clinicians to counsel patients on outcomes of transsphenoidal excision of benign pituitary tumors.
2. Addressing modifiable risk factors prior to surgery could reduce length of hospital stay and discharge with continued care, thereby improving surgical cost-effectiveness.
Learning Objectives: 1. Transsphenoidal excision of benign pituitary tumors is associated with relatively few adverse outcomes, but varying lengths of hospital stay.
2. Duration of surgery, minority race, ASA class greater than 2, and emergency surgery are together strongly predictors for prolonged LOS, while undergoing surgery at an academic hospital is a protective factor.
3. Advanced age and current smoking status are strong predictors for discharge with continued care.