Introduction: Transsphenoidal surgery (TSS) for pituitary lesions is performed on elderly patients with increasing frequency. We aimed to retrospectively study postoperative safety outcomes following TSS in the elderly population stratified by decade of life.
Methods: A retrospective chart review of the Keck Medical Center of USC Pituitary Database was conducted to identify patients >70 years who underwent transsphenoidal surgery for pituitary adenomas between January 1995-February 2017. Surgical outcomes were analyzed in elderly (>70) versus non-elderly (<70) patients. Elderly patients were additionally stratified according to age (70-79 versus >80 years).
Results: The cohorts included 115 elderly patients (70-79 years: 94 patients; >80 years: 21 patients) and 770 non-elderly patients. Geriatric patients presented with higher rates of vision loss (59% vs 38%, p<0.01), dizziness (17% vs 7.8%, p<0.01) and altered mental status (7.3% vs 3%, p<0.05). Mean tumor diameter in the elderly vs. non-elderly groups was 25.25 vs. 21.99 mm (p<0.05). The proportion of complication free procedures was similar in both cohorts: 75.5 % in elderly vs 73.1% in younger patients. Geriatric patients had higher rates of postoperative hyponatremia (10.2% vs. 4.7%, p<0.05) and lower rates of transient diabetes insipidus (0.9% vs. 7.9%, p<0.01). Patients >80 had higher rates of hyponatremia compared to those 70-79 (15.8% vs 9.0%, p<0.40) and higher rates of cranial nerve palsy (10.5% vs. 0%, p< 0.03). The mean hospital stay in the younger group was 3.6 days compared to 3.8 days in geriatrics (70-79, 3.6 days; >80, 4.8 days).
Conclusions: When carefully selected, patients >70 years may be appropriate surgical candidates for transsphenoidal surgery given the similar safety outcomes as younger patients. Given the higher propensity for medical and surgical complications, a higher level of operative selectivity should be maintained in octogenarian patients.
Patient Care: In analyzing these characteristics we hope to gain a greater knowledge on how the elderly population differs in terms of clinical presentation, surgical complication rate, and follow-up outcomes in order to better understand the most appropriate clinical management of elderly patients presenting with pituitary adenomas.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Describe the differences in clinical presentation, surgical complications, and postoperative outcomes between geriatric and non-geriatric patient populations.
2. Discuss in small groups how patients 70-79 years of age differ from those >80 years in terms of post-operative complications.
3. Understand the importance of research on the complications occurring in the geriatric population undergoing transphenoidal surgery for pituitary adenomas.