Parikh Adish, Adapa Arjun, Sullivan Stephen E, McKean Erin L
Department of Otolaryngology Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
J Neurol Surg B Skull Base. 2020 Feb;81(1):43-55. doi: 10.1055/s-0039-1679896. Epub 2019 Feb 18.
Cerebrospinal fluid (CSF) leak is a complication of endoscopic endonasal pituitary adenoma resection. Previous studies examining complications of pituitary adenoma resection have not examined associations of an exhaustive list of clinical and financial variables with CSF leak. We designed a retrospective analysis of 334 consecutive patients that underwent endoscopic endonasal pituitary adenoma resection at a single institution over 5 years, analyzing associations between CSF leak and demographic data, operative data, comorbidities, clinical complications and outcomes, costs, charges, and payments. Of the 20 preoperative variables studied, none were positively associated with CSF leak in between-groups comparison, although multivariate analysis revealed an association with a history of radiation to the skull base (odds ratio [OR], 8.67; 95% confidence interval [CI], 0.94-57.03; < 0.05). CSF leak was associated with a significantly higher rate of postoperative diabetes insipidus (Δ = 33.4%, = 0.040) and increased length of stay after operation in between-groups comparison. Multivariate analysis on postoperative variables revealed significant associations between CSF leak and intracerebral hemorrhage (OR, 17.44; 95% CI, 0.65-275.3; < 0.05) and postoperative intracranial infection (OR, 28.73; 95% CI, 2.04-438.7; < 0.05). Also, CSF leak was associated with significantly higher costs (Δ = $15,643, < 0.05) and hospital charges (Δ = $46,026, < 0.05). Operating room time, room and board, and supplies and implants were the strongest cost drivers. This study highlights the difficulty of utilizing preoperative variables to predict CSF leak, the clinical complications and outcomes of leak, and the financial subcategories that drive the costs, charges, and payments associated with this complication.
脑脊液漏是经鼻内镜垂体腺瘤切除术的一种并发症。以往关于垂体腺瘤切除术并发症的研究并未考察一系列详尽的临床和财务变量与脑脊液漏之间的关联。我们对一家机构在5年内连续接受经鼻内镜垂体腺瘤切除术的334例患者进行了回顾性分析，分析脑脊液漏与人口统计学数据、手术数据、合并症、临床并发症及转归、费用、收费和支付之间的关联。在所研究的20个术前变量中，组间比较时无变量与脑脊液漏呈正相关，不过多因素分析显示与颅底放疗史有关联（比值比[OR]为8.67；95%置信区间[CI]为0.94 - 57.03；P < 0.05）。组间比较时，脑脊液漏与术后尿崩症发生率显著较高（差值 = 33.4%，P = 0.040）及术后住院时间延长有关。对术后变量的多因素分析显示，脑脊液漏与脑出血（OR为17.44；95% CI为0.65 - 275.3；P < 0.05）和术后颅内感染（OR为28.73；95% CI为2.04 - 438.7；P < 0.05）之间存在显著关联。此外，脑脊液漏还与显著更高的费用（差值 = 15,643美元，P < 0.05）和医院收费（差值 = 46,026美元，P < 0.05）有关。手术室时间、食宿以及耗材和植入物是最强的费用驱动因素。本研究凸显了利用术前变量预测脑脊液漏的难度、脑脊液漏的临床并发症及转归，以及导致与该并发症相关的费用、收费和支付的财务子类别。
