In-Hospital Postoperative Complications in Patients With Pituitary Adenoma Who Underwent Pituitary Surgery From January 2010 to December 2015: A Multicenter Study

Abstract

Background: Unwanted postoperative complications in pituitary surgeries pose significant morbidity and mortality. We examine the various in-hospital postoperative complications in two tertiary training hospitals. Methods: This is a retrospective cohort study. Clinical, biochemical/hormonal and neuroradiological evaluations were described. Postoperative complications were determined during the entire length of hospital stay. Results: A total of 71 patients with pituitary adenoma who underwent pituitary surgery were studied. The mean age was 44 years old (range 18 - 77), female to male distribution was 1:1 (36:35), and mean body mass index (BMI) was 25 kg/m 2 . The most common clinical presentation was visual disturbances (80%), headache (49%), and nausea and vomiting (21%). Hypopituitarism was present in 32 patients (45%). Seventy percent were macroadenomas. Non-functioning pituitary adenoma (NFPA) predominated (78%), followed by prolactinoma (17%), adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma (Cushing’s disease) (4%) and growth hormone (GH)-secreting pituitary adenoma (acromegaly) (1%). Giant pituitary adenoma was noted in 20%. In-hospital postoperative complications occurred in 23 patients (32%). The identified complications were diabetes insipidus (22.5%), intracranial hemorrhage/hematoma (8.5%), transient cerebrospinal fluid (CSF) leak (7%), worsening of vision (2.8%), headache (2.8%), obstructive hydrocephalus (2.8%), seizure (2.8%), death (2.8%), and hospital-acquired pneumonia (1.4%). Among the possible risk factors for the onset of complications, width of the tumor was the variable that reached statistical significance (P = 0.018). Conclusion: Pituitary surgery is relatively safe. The most common immediate postoperative complications were diabetes insipidus, intracranial hemorrhage/hematoma and CSF leak. Larger tumor size was determined to be a risk factor for the onset of these complications. J Endocrinol Metab. 2017;7(4):122-130 doi: https://doi.org/10.14740/jem429w