Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Int Forum Allergy Rhinol. 2020 Jun;10(6):785-790. doi: 10.1002/alr.22540. Epub 2020 May 3.
Endoscopic transsphenoidal surgery (ETS) for the resection of pituitary adenoma has become more common throughout the past decade. Although most patients have a short postoperative hospitalization, others require a more prolonged stay. We aimed to identify predictors for prolonged hospitalization in the setting of ETS for pituitary adenomas.
A retrospective chart review as performed on 658 patients undergoing ETS for pituitary adenoma at a single tertiary care academic center from 2005 to 2019. Length of stay (LoS) was defined as date of surgery to date of discharge. Patients with LoS in the top 10th percentile (prolonged LoS [PLS] >4 days, N = 72) were compared with the remainder (standard LoS [SLS], N = 586).
The average age was 54 years and 52.5% were male. The mean LoS was 2.1 days vs 7.5 days (SLS vs PLS). On univariate analysis, atrial fibrillation (p = 0.002), hypertension (p = 0.033), partial tumor resection (p < 0.001), apoplexy (p = 0.020), intraoperative cerebrospinal fluid (ioCSF) leak (p = 0.001), nasoseptal flap (p = 0.049), postoperative diabetes insipidus (DI) (p = 0.010), and readmission within 30 days (p = 0.025) were significantly associated with PLS. Preoperative continuous positive airway pressure (CPAP) (odds ratio, 15.144; 95% confidence interval, 2.596-88.346; p = 0.003) and presence of an ioCSF leak (OR, 10.362; 95% CI, 2.143-50.104; p = 0.004) remained significant on multivariable analysis.
For patients undergoing ETS for pituitary adenomas, an ioCSF leak or preoperative use of CPAP predicted PLS. Additional common reasons for PLS included postoperative CSF leak (10 of 72), management of DI or hypopituitarism (15 of 72), or reoperation due to surgical or medical complications (14 of 72).
内镜经鼻蝶窦手术（ETS）切除垂体腺瘤在过去十年中变得越来越普遍。尽管大多数患者术后住院时间较短，但也有一些患者需要更长的住院时间。我们旨在确定 ETS 治疗垂体腺瘤患者住院时间延长的预测因素。
对 2005 年至 2019 年期间在一家三级学术中心接受 ETS 治疗的 658 例垂体腺瘤患者进行回顾性图表审查。住院时间（LoS）定义为手术日期至出院日期。将 LoS 在前 10%的患者（延长 LoS [PLS] >4 天，N=72）与其余患者（标准 LoS [SLS]，N=586）进行比较。
平均年龄为 54 岁，52.5%为男性。平均 LoS 为 2.1 天 vs 7.5 天（SLS vs PLS）。单因素分析显示，心房颤动（p=0.002）、高血压（p=0.033）、部分肿瘤切除（p<0.001）、中风（p=0.020）、术中脑脊液漏（p=0.001）、鼻中隔瓣（p=0.049）、术后尿崩症（p=0.010）和 30 天内再入院（p=0.025）与 PLS 显著相关。术前持续气道正压通气（CPAP）（优势比，15.144；95%置信区间，2.596-88.346；p=0.003）和术中脑脊液漏的存在（OR，10.362；95%CI，2.143-50.104；p=0.004）在多变量分析中仍然显著。
对于接受 ETS 治疗垂体腺瘤的患者，术中脑脊液漏或术前使用 CPAP 可预测 PLS。PLS 的其他常见原因包括术后脑脊液漏（72 例中的 10 例）、糖尿病或垂体功能减退的管理（72 例中的 15 例）或因手术或医疗并发症而再次手术（72 例中的 14 例）。
