title: Complications following primary and revision transsphenoidal surgeries for pituitary tumors.
abstract: OBJECTIVE
  This study aimed to determine the incidence of major complications following both primary and revision transsphenoidal pituitary surgery. Major complications included endocrinopathic, skull base, orbital, hemorrhagic and thromboembolic complications, respiratory failure, and death. Secondarily, this study aimed to examine factors associated with the occurrence of complications.
  
  
  METHODS
  Retrospective cohort analysis of California and Florida all-payer databases from 2005 to 2008.
  
  
  METHODS
  The major complication rate following both primary and revision transsphenoidal pituitary surgery was calculated. Bivariate analyses were performed to investigate the relationship of patient characteristics with complication occurrence, and a multivariate model was constructed to determine risk factors associated with these complications.
  
  
  RESULTS
  There were 5,277 primary cases and 192 revision cases that met inclusion criteria. There was a nonsignificant absolute difference of 3.09% (95% confidence interval [CI]: -11.00 to 16.14) between the rate of complications following primary (n = 443, 8.39%) and revision (n = 22, 11.46%) surgeries. Multivariate analyses showed that patients with Medicare (odds ratio [OR]:1.74, 95% CI: 1.17 to 2.61), Medicaid (OR: 2.13, 95% CI: 1.59 to 2.86), or a malignant neoplasm (OR: 3.10, 95% CI: 1.62 to 5.93) were more likely to have complications.
  
  
  CONCLUSIONS
  The rate of major complications following transsphenoidal pituitary surgery is lower than earlier retrospective reports. The overall complication rate following revision surgery was not significantly different from primary surgery. Insurance status and a diagnosis of a malignant neoplasm were associated with a higher rate of complications.
  
  
  METHODS
  2C.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri; Stanford Medical Scholars Fellowship, Stanford University School of Medicine, Stanford, California.
authors.forename: James G
authors.initials: JG
authors.lastname: Krings
authors.forename: Dorina
authors.initials: D
authors.lastname: Kallogjeri
authors.forename: Andre
authors.initials: A
authors.lastname: Wineland
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Nepple
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
authors.forename: Anne E
authors.initials: AE
authors.lastname: Getz
mesh_terms: D000236:Adenoma / Q000601:surgery*; D002140:California / Q000453:epidemiology; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*
keywords: Transsphenoidal surgery; cerebrospinal fluid leak; complications; diabetes insipidus; diplopia; hemorrhage; orbital hematoma; panhypopituitarism; pituitary adenomas; vision loss