title: Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery.
abstract: OBJECTIVE
  Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery.
  
  
  METHODS
  An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery.
  
  
  RESULTS
  This study is a retrospective review of a subgroup of patients studied in the clinical trial "Rhinological Outcomes in Endonasal Pituitary Surgery" (clinical trial no. NCT01504399, clinicaltrials.gov ). Data from 100 patients who underwent fully endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were use of nasal splints (p = 0.039) and female sex at the trend level (p = 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (p = 0.025), advancing age (p = 0.044), and use of absorbable nasal packing (p = 0.014). Health status (multidimensional QOL) was also predictive at 2 weeks (p = 0.001) and 3 months (p < 0.001) and was the only significant predictor of sinonasal QOL at 6 months (p < 0.001). A Kaplan-Meier analysis was performed to study time to resolution of nasal crusting, mucopurulence, and synechia as observed during nasal endoscopy after surgery. The mean time (± SEM) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopurulence.
  
  
  CONCLUSIONS
  Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 weeks and recovers by 3 months postoperatively. Use of absorbable packing and nasal splints, while used in a minority of patients, negatively correlates with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.
authors.affiliation: 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Little
authors.forename: Daniel
authors.initials: D
authors.lastname: Kelly
authors.affiliation: 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: John
authors.initials: J
authors.lastname: Milligan
authors.forename: Chester
authors.initials: C
authors.lastname: Griffiths
authors.affiliation: 3Department of Neurosurgery, The Ohio State University, Columbus, Ohio; and.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
authors.affiliation: 3Department of Neurosurgery, The Ohio State University, Columbus, Ohio; and.
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.affiliation: 4Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Gail
authors.initials: G
authors.lastname: Rosseau
authors.forename: Garni
authors.initials: G
authors.lastname: Barkhoudarian
authors.affiliation: 3Department of Neurosurgery, The Ohio State University, Columbus, Ohio; and.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Otto
authors.affiliation: 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: Heidi
authors.initials: H
authors.lastname: Jahnke
authors.forename: Charlene
authors.initials: C
authors.lastname: Chaloner
authors.affiliation: 3Department of Neurosurgery, The Ohio State University, Columbus, Ohio; and.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Jelinek
authors.affiliation: 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: Kristina
authors.initials: K
authors.lastname: Chapple
authors.affiliation: 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: William L
authors.initials: WL
authors.lastname: White
mesh_terms: D000236:Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods; D009666:Nose / Q000601:surgery*; D009668:Nose Diseases / Q000209:etiology*; D010256:Paranasal Sinuses / Q000601:surgery*; D010902:Pituitary Gland / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ASK Nasal-12 = Anterior Skull Base Nasal Inventory-12; QOL = quality of life; SF-8 = 8-item Short-Form Health Survey; endoscopic surgery; pituitary adenoma; pituitary surgery; quality of life; sinusitis; transsphenoidal surgery