title: Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?
abstract: To explore the relationship between lower airway disease and postoperative cerebrospinal fluid (CSF) rhinorrhea among patients undergoing pituitary surgery STUDY DESIGN: Retrospective review.
  
  
  
  A retrospective review of the Healthcare Cost and Utilization Project's 2013 National Inpatient Sample was conducted to characterize the hospital stay and surgical outcomes of patients undergoing pituitary surgery. Patients with lower airway disease (including chronic obstructive pulmonary disease and asthma) were compared to a disease-free population identifying demographics and complications over-represented in the lower airway group.
  
  
  
  The majority of hypophysectomies (92.1%) were performed via a transsphenoidal approach. Among transsphenoidal patients, individuals with asthma (92.8% of the lower airway disease cohort) harbored a greater postoperative CSF leak rate (4.7% vs. 2.7%, P = .022), and were more likely to develop postoperative diabetes insipidus (6.2% vs. 4.1%, P = .024) and neurological complications (13.0% vs. 9.6%, P = .010) when compared to a lower airway disease-free cohort. Patients with CSF rhinorrhea had longer lengths of stay (7.8 days vs. 4.5 days, P < .001) and higher discharge costs ($148,309 vs. $76,246, P < .001). A binary logistic regression model identified having asthma (P = .042), being female (P = .011), and having gastroesophageal reflux disease (P = .006) as independent predictors of postoperative CSF rhinorrhea.
  
  
  
  Several patient comorbidities including asthma are associated with a greater risk of postoperative CSF rhinorrhea. Perioperative lower airway assessment and disease control may potentially decrease one's risk of this complication, although further inquiry is urgently needed to identify optimal preventive strategies.
  
  
  
  2c. Laryngoscope, 127:1543-1550, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
authors.forename: Curtis
authors.initials: C
authors.lastname: Hanba
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Michigan Head and Spine Institute, Novi, Michigan, U.S.A.|William Beaumont Health System, Royal Oak, Michigan, U.S.A.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jacob
authors.affiliation: Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
authors.forename: Murali
authors.initials: M
authors.lastname: Guthikonda
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.|Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.|Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003919:Diabetes Insipidus / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000191:economics; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D055815:Young Adult
keywords: Hypophysectomy; Nationwide Inpatient Sample; pituitary surgery; transsphenoidal