Introduction: It is thought that multidisciplinary team-based management approaches are linked to improved outcomes. This assertion has not been investigated in transsphenoidal pituitary surgery.
Methods: Using a national database (Truven-Marketscan), we identified surgeon-specialty in transsphenoidal pituitary surgery and examined the incidence and likelihood of specific post-operative complications between the following management approaches: cases involving only-neurosurgeon, cases involving only-otolaryngologist, and cases involving neurosurgeon-otolaryngologist combination.
Results: Of 4,614 cases, 53.14% were microscopic, and 46.86% were endoscopic, involving only-neurosurgeon (52.49%), only-otolaryngologist (7.85%), and neurosurgeon-otolaryngologist team (39.66%) approaches. Majority of endoscopic surgeries involved neurosurgeon-otolaryngologist team (53.84%) (p<0.001). On the other hand, microsurgical techniques mostly involved only-neurosurgeon (67.25%) (p<0.001).
Overall, the incidences of specific post-operative complications were as follows: disorders of the pituitary (18.55%) [including diabetes insipidus (16.34%)], fluid/electrolyte disorders (10.99%), hemorrhagic complications (3.73%) [including epistaxis (0.89%)], cerebrospinal fluid (CSF) leaks (10.32%) [including CSF-rhinorrhea (4.23%), dura-tear (1.32%)], and ophthalmologic complications (7.87%).
Comparison of rates of specific postoperative complications across only-neurosurgeon versus only-otolaryngologist versus neurosurgeon-otolaryngologist team approaches revealed the following significant differences: CSF-leaks (9.37% vs. 16.30% vs. 10.38%), including CSF-rhinorrhea (3.59% vs. 8.29% vs. 4.26%), and dura-tears (0.91% vs. 2.76% vs. 1.58%) (all p<0.001); and epistaxis (1.49% vs. 0.55% vs. 0.16%, p<0.001).
Propensity-adjusted multivariate analysis showed that compared to neurosurgeon-otolaryngologist team, the odds-ratios of CSF-leaks was significantly higher among only-otolaryngologist (OR=1.67; 95%CI=1.21-2.30), but not only-neurosurgeon (OR=1.09; 95%CI=0.88-1.35, P=0.44), while odds-ratios of epistaxis was significantly higher among only-neurosurgeons (OR=10.09; 95%CI=3.09-33.55, P<0.001) but not only-otolaryngologist (OR=3.16; 95%CI=0.52-19.12; P=0.21).
There were no significant differences in mortality (p=0.90) between the different management approaches.
Conclusions: There is demonstrable evidence of improved outcomes in transsphenoidal pituitary resection associated with neurosurgeon-otolaryngologist team-based approach, with a resultant 1 to 10-fold reduction in risk of post-operative cerebrospinal fluid leaks/fistulas and epistaxis among patients. These findings would warrant further validation in prospective cohorts.
Patient Care: By improving the evidence base for patient management
Learning Objectives: To improve issues that pertain to improved outcomes for patients undergoing transsphenoidal surgery