Introduction: Microsurgical and endoscopic techniques are commonly utilized surgical approaches to access pituitary pathologies. There is limited data comparing these two surgical procedures.This study evaluates postoperative complications and associated costs of microscopic and endoscopic techniques, and offers a unique perspective by examining national and regional differential trends in the United States employing a nationwide database.
Methods: The Truven Market-scan database 2010-2014 was queried and Concurrent Procedural Terminology codes identified patients that underwent microscopic and/or endoscopic transsphenoidal pituitary surgery. International Classification of Diseases codes identified postoperative complications. Adjusted logistic regression and matched propensity analysis evaluated independent odds for complications.
Results: Among 5,886 cases studied, 54.49% were microscopic and 45.51% endoscopic. The commonest surgical indications were benign pituitary tumors. Annual trends showed increasing utilization of endoscopic techniques versus microscopic procedures (See attached Figure 1). Postoperative complications occurred in 40.04% of cases, including diabetes insipidus [16.90%], syndrome of inappropriate anti-diuretic hormone (SIADH) [2.02%], iatrogenic hypopituitarism [1.36%], fluid/electrolyte abnormalities (hypoosmolality/hyponatraemia [5.03%] and hyperosmolality/hypernatraemia [2.48%]), and cerebrospinal fluid (CSF) leaks (CSF-rhinorrhoea [4.42%] and other CSF-leak [6.52%]). In our propensity based model, patients that underwent endoscopic surgery were more likely to develop diabetes insipidus [OR=1.48; 95%CI=1.28-1.72], SIADH [OR=1.53; 95%CI=1.04-2.24], hypoosmolality/hyponatraemia [OR=1.17; 95%CI=1.01-1.34], CSF-rhinorrhoea [OR=2.48; 95%CI=1.88-3.28], other CSF leak [OR=1.59; 95%CI=1.28-1.98], altered mental status [OR=1.46; 95%CI=1.01-2.60], and postoperative fever [OR=4.31; 95%CI=1.14-16.23]. Postoperative complications resulted in longer hospitalization and increased healthcare costs.
Conclusions: Endoscopic approaches are increasingly being utilized to manage sellar pathologies relative to microsurgery. Postoperative complications occur in both techniques, with higher incidences of complications observed following endoscopic procedures.
Patient Care: This research will help to improve patient care by evaluating current trends and practice patterns in the management of pituitary pathologies. Through evaluation of outcomes of patients undergoing surgery, it also helps to provide a benchmark for further improvement of current standards.
Learning Objectives: This study estimates trends in the overall burden and incidence of complications associated with microscopic and endoscopic transsphenoidal pituitary surgery.
It also examines the costs of hospitalization associated with the development of complications.
This analysis which was performed on data obtained from a national database is representative of a wide range of patients and /or practice settings. It differs uniquely from previous studies which are either limited to single institutions or to a limited number of practice settings.
Thus, the findings obtained from this unique study generalize more broadly across the entire spectrum of patients undergoing transsphenoidal pituitary surgery and provides a strong evidence base for the ongoing microsurgical-endoscopic transition in the management of pituitary pathologies.