Shah Khushi H, Susic Nikola, DiStefano Nicholas V, Knott Maxon V, Khalafallah Adham M, Lu Victor M, Benjamin Carolina G, Shah Ashish H, Sargi Zoukaa B, Komotar Ricardo J, Ivan Michael E
Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 2nd Floor, Miami, Fl, 33136, USA.
Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, FL, USA.
Pituitary. 2025 Jan 25;28(1):21. doi: 10.1007/s11102-024-01483-z.
Prolonged length of stay (PLOS) can lead to resource misallocation and higher complication risks. However, there is no consensus on defining PLOS for endoscopic transsphenoidal pituitary surgery (ETPS). Therefore, we investigated the impact of varying PLOS definitions on factors associated with PLOS in patients undergoing ETPS.
We conducted a retrospective review of patients with pituitary adenomas who underwent ETPS at our institution from 2012 to 2023. Patients were divided into non-PLOS and PLOS groups based on varying definitions of PLOS: > median, > 4 days, > 75th percentile, and > 90th percentile. Bivariate statistical analyses were conducted using Fisher's exact test, chi-square test, and t-tests. Univariate and multivariate logistic regression identified significant predictors for each PLOS definition.
Our cohort (n = 808) had a mean age of 54.37 ± 16.06 years, 50.43% male, and a median LOS of 3 days. The 75th and 90th percentiles of LOS were 4 and 6 days, respectively. The way PLOS was defined influenced associated factors identified. Preoperative KPS score, non-private insurance, and non-home discharge disposition were associated with PLOS across all definitions used (p < 0.05). Increased preoperative tumor volumes and postoperative hyponatremia were associated with PLOS only when defined by the 75th and 90th percentiles (p < 0.05). Non-White race and low income were significantly associated with PLOS > median while intraoperative CSF leak was a significant predictor for PLOS > 90th percentile (p < 0.05).
Our study highlights the variability in predictors of PLOS based on its definition and emphasizes the role of non-clinical factors on LOS.
住院时间延长（PLOS）会导致资源分配不当和并发症风险增加。然而，对于内镜经蝶窦垂体手术（ETPS）中PLOS的定义尚无共识。因此，我们研究了不同的PLOS定义对ETPS患者中与PLOS相关因素的影响。
我们对2012年至2023年在本机构接受ETPS的垂体腺瘤患者进行了回顾性研究。根据PLOS的不同定义，将患者分为非PLOS组和PLOS组：>中位数、>4天、>第75百分位数和>第90百分位数。使用Fisher精确检验、卡方检验和t检验进行双变量统计分析。单变量和多变量逻辑回归确定了每个PLOS定义的显著预测因素。
我们的队列（n = 808）平均年龄为54.37±16.06岁，男性占50.43%，中位住院时间为3天。住院时间的第75和第90百分位数分别为4天和6天。PLOS的定义方式影响了所确定的相关因素。在所有使用的定义中，术前KPS评分、非私人保险和非家庭出院处置与PLOS相关（p < 0.05）。仅当按第75和第90百分位数定义时，术前肿瘤体积增加和术后低钠血症与PLOS相关（p < 0.05）。非白人种族和低收入与PLOS>中位数显著相关，而术中脑脊液漏是PLOS>第90百分位数的显著预测因素（p < 0.05）。
我们的研究强调了基于PLOS定义的预测因素的变异性，并强调了非临床因素对住院时间的作用。
