title: Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery.
abstract: BACKGROUND
  The goal of this study was to identify preoperative risk factors associated with increased perioperative morbidity after endoscopic pituitary surgery.
  
  
  METHODS
  A retrospective review of patients undergoing endoscopic pituitary adenoma surgery between 2002 and 2014 at 6 international centers was performed. Standard demographic and comorbidity data, as well as information regarding tumor extent and treatment were collected. Logistic regression was used to examine risk factors for the following 30-day outcomes: systemic complications, intracranial complications, postoperative cerebrospinal fluid (CSF) leaks, length of hospital stay, readmission, and reoperation.
  
  
  RESULTS
  Data was collected on 982 patients with a mean age of 52 years. The median body mass index (BMI) for all patients was 30.9 kg/m(2) with 56% female. The median hospital stay was 5 days and 23.8% of patients suffered a postoperative adverse event. Systemic complications occurred in 3.2% of patients and intraventricular extension was a risk factor (odds ratio [OR] 8.9). Intracranial complications occurred in 7.3% of patients and risk factors included previous radiation (OR 8.6) and intraventricular extension (OR 7.9). Reoperation occurred in 6.5% of patients and intraventricular extension (OR 7.3) and age (<40 years, OR 3.5; 40 to 64 years, OR 3.2) were risk factors. Postoperative CSF leaks occurred in 5.5% of patients and risk factors included female gender (OR 2.4), BMI ≥ 30 (OR 2.1), age (<40 years, OR 5.3; 40 to 64 years, OR, 7.9), and intraventricular extension (OR, 9.5).
  
  
  CONCLUSIONS
  Postoperative endoscopic pituitary adenoma surgery complications are associated with tumors with intraventricular extension, preoperative radiation, as well as common patient comorbidities. Identification of these factors may permit implementation of strategies to reduce postoperative complications.
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Caitlin C
authors.initials: CC
authors.lastname: Boling
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Tom T
authors.initials: TT
authors.lastname: Karnezis
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Baker
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Lawrence
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, SC.
authors.forename: W Alexander
authors.initials: WA
authors.lastname: Vandergrift
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Wise
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA.
authors.forename: John M
authors.initials: JM
authors.lastname: DelGaudio
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA.
authors.forename: Zara M
authors.initials: ZM
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA.
authors.forename: Shruthi K
authors.initials: SK
authors.lastname: Rereddy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: John M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Mohemmed N
authors.initials: MN
authors.lastname: Khan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Satish
authors.initials: S
authors.lastname: Govindaraj
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia.
authors.forename: Chun
authors.initials: C
authors.lastname: Chan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Modbury Hospital, Adelaide, Australia.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Oue
authors.affiliation: University of Adelaide, Adelaide, Australia.
authors.forename: Alkis J
authors.initials: AJ
authors.lastname: Psaltis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Adelaide, Australia.
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
authors.affiliation: Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors.forename: Samuel
authors.initials: S
authors.lastname: Trosman
authors.affiliation: Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors.forename: Janalee
authors.initials: J
authors.lastname: Stokken
authors.affiliation: Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors.forename: Troy
authors.initials: T
authors.lastname: Woodard
authors.affiliation: Head and Neck Institute and the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D010359:Patient Readmission / Q000706:statistics & numerical data; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D057234:Preoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: CSF leak; complication; endoscopic; pituitary; skull base