Complications and death among elderly patients undergoing pituitary tumour surgery.
BACKGROUND
Preoperative determinants of surgical risk in elderly patients with pituitary tumour are not fully defined. The aim of this study was to quantify operative risk for these patients.


METHODS
We performed a retrospective analysis of the Nationwide Inpatient Sample (1998-2005), a database containing discharge information from a stratified, random sample of 20% of all non-federal hospitals in 37 states. Patients >65 years old who underwent pituitary tumour resection were identified by ICD-9 coding. Primary outcome was inpatient death. Other outcomes included post-operative complications, length of stay (LOS) and total charges.


RESULTS
A total of 8400 patients (53.7% male) were identified. Mean age was 72.2. Mean co-morbidity score was 5.3. A majority were white (82.0%) admitted to academic hospitals (69.5%) for elective procedures (55.7%). Inpatient mortality was 3.8%. The most common complication was fluid and electrolyte abnormalities (14.3%). Mean LOS was 8.5 days. In multivariate analysis, patients >80 years old had 30% greater odds of death, relative to 65-69 year old counterparts. Each complication increased LOS by an average of at least 4 days. These associations were statistically significant (P-values <0.05).


CONCLUSIONS
New clinically relevant risk stratification information is now available to assist clinicians in operative decision-making for elderly patients with pituitary tumour considering operative intervention.
Grossman
Rachel
R
Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, MD, USA.
Mukherjee
Debraj
D
Chaichana
Kaisorn L
KL
Salvatori
Roberto
R
Wand
Gary
G
Brem
Henry
H
Chang
David C
DC
Quiñones-Hinojosa
Alfredo
A
D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010911:Pituitary Neoplasms / Q000208:ethnology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D044465:White People / Q000706:statistics & numerical data