Characterization of transsphenoidal complications in patients with acromegaly: an analysis of inpatient data in the United States from 2002 to 2010.
BACKGROUND
Transsphenoidal surgery (TSS) is a common procedure for a variety of pituitary lesions. This procedure can be associated with complications related to the surgery or specific pathology. In this study, we evaluate inpatient postoperative complications among patients who underwent TSS for growth hormone adenomas using a nationally representative database, and compare patient characteristics and complications to patients who underwent TSS for other benign pituitary neoplasms.


METHODS
Analysis of the Nationwide Inpatient Sample revealed 13,070 TSS patients (including 892 with acromegaly) between 2002 and 2010. Complication rates, outcomes, patient demographics, hospital stay, and total charges were evaluated among TSS patients with and without acromegaly.


RESULTS
There was an increase in TSS performed in both cohorts from 2002 to 2010. Acromegaly patients were younger, had shorter hospital stays, and incurred fewer charges. Acromegaly patients had a lower occurrence of postoperative urinary/renal complications (0.2% vs 1.1%), thromboembolic events (0% vs 0.4%), fluid/electrolyte abnormalities (5.7% vs 9.1%), and iatrogenic hypopituitarism (0.3% vs 1.1%) compared to other TSS patients (all p < 0.05). After adjusting for age, acromegalic patients maintained a statistically lower occurrence of fluid/electrolyte abnormalities (p = 0.007). Cerebrospinal fluid leak occurrence in acromegaly patients was 2.6% vs 1.7% in non-acromegaly patients, a result that did not reach significance (p = 0.054).


CONCLUSIONS
Upon comparison of inpatient hospitalizations for patients undergoing TSS for growth hormone adenomas and other benign pituitary neoplasms, acromegaly patients had a significantly lower occurrence of postoperative fluid/electrolyte abnormalities. Acromegaly patients had shorter hospitalizations and subsequently fewer total charges.
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Milap D
MD
Raikundalia
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Morgan J
MJ
Pines
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI.
Peter F
PF
Svider
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.
Soly
S
Baredes
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI.|Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI.
Adam J
AJ
Folbe
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.
James K
JK
Liu
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Jean Anderson
JA
Eloy
D000172:Acromegaly / Q000150:complications*; D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery; D014481:United States; D014882:Water-Electrolyte Balance
CSF rhinorrhea; acromegaly; benign pituitary neoplasm; cerebrospinal fluid leak; diabetes insipidus; gigantism; growth hormone; growth hormone adenoma; iatrogenic hypopituitarism; nationwide inpatient sample; pituitary surgery; transsphenoidal