A50 Rationalization of the postoperative care in transsphenoidal pituitary surgery

Abstract

Background and Goal of study: A safe postoperative care with accurate resources is not well defined in the neuroendoscopic transsphenoidal pituitary surgery. The objective of our prospective study was to assess post-operative management according to a two levels risk classification. Materials and methods: Analysis of anaesthesia records (drugs, ECG, PA invasive, PVC, TOF, T, BIS and bilateral rSO2.) and perioperative complications in all scheduled patients operated on between 2006 and 2011 divided in two groups. A “high risk group” (HRG) of patients above 60 year's old, severe comorbidity, clinically active acromegaly, Cushing's disease, large tumour with risk of hypothalamic affectation or intraoperative or early postoperative complications. All sent postoperatively to an ICU for 24 h. “Low risk group” (LRG) were controlled in a post-anaesthesia recovery unit for 6 h and then sent to neurosurgical ward. Results: A total of 126 patients were included (56.3% women, 43.7% men), mean age 51.5 ± 16.4 years. Diagnoses: acromegaly 27.8%, Cushing's Sd 11.92.7% and others (prolactinoma, non secreting macro and microadenoma) 46%. 65.9% belonged to HRG and 34.1% met LRG criteria. Intraoperative complications appeared in 32.5% of the HRG (n = 27),and 14%(n = 6) in LRG all them minors. A 26%(n = 33) had intraoperative complications in both groups, including two major complications (internal carotid injury). Postoperative complications in both groups 13%(n = 17), 11%(n = 14) severe (bleeding, reoperation, stroke, acute myocardial infarction, pneumonia). In the high risk group 19%(n = 16), low risk group 2%(n = 1). Mortality in HRG: 2.4%(n = 2) secondary to the two internal carotid injuries, none in the LRG. Conclusions/ Discussion: The risk assessment scale proposed was useful to identify high-risk patients submitted to neuroenscopic transsphenoidal pituitary surgery.