Comparison of Complications, Trends, and Costs in Endoscopic vs Microscopic Pituitary Surgery: Analysis From a US Health Claims Database. Issue 3 (September 2017)

• Record Type: Journal Article
• Authors: Asemota, Anthony O.; Ishii, Masaru; Brem, Henry; Gallia, Gary L.
• Is Part Of: Neurosurgery. Volume 81:Issue 3(2017)
• Publication Date: 2017-09
• Subjects: Endonasal -- Endoscopic -- Microscopic -- Pituitary adenoma -- Skull base surgery -- Transsphenoidal; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyx350
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: : Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. There are limited data comparing these 2 procedures. OBJECTIVE: : To evaluate postoperative complications, associated costs, and national and regional trends of microscopic and endoscopic techniques in the United States employing a nationwide database. METHODS: : The Truven MarketScan database 2010 to 2014 was queried and Current Procedural Terminology codes identified patients that underwent microscopic and/or endoscopic transsphenoidal pituitary surgery. International Classification of Diseases codes identified postoperative complications. Adjusted logistic regression and matched propensity analysis evaluated independent odds for complications. RESULTS: : Among 5886 cases studied, 54.49% were microscopic and 45.51% endoscopic. The commonest surgical indications were benign pituitary tumors. Annual trends showed increasing utilization of endoscopic techniques vs microscopic procedures. Postoperative complications occurred in 40.04% of cases, including diabetes insipidus (DI; 16.90%), syndrome of inappropriate antidiuretic hormone (SIADH; 2.02%), iatrogenic hypopituitarism (1.36%), fluid/electrolyte abnormalities (hypoosmolality/hyponatraemia [5.03%] and hyperosmolality/hypernatraemia [2.48%]), and cerebrospinal fluid (CSF) leaks (CSF rhinorrhoea [4.42%] and other CSF leak [6.52%]). In our propensity‐based model, patients that underwent endoscopic surgery were more likely to develop DI (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.28–1.72), SIADH (OR = 1.53; 95% CI = 1.04–2.24), hypoosmolality/hyponatraemia (OR = 1.17; 95% CI = 1.01–1.34), CSF rhinorrhoea (OR = 2.48; 95% CI = 1.88–3.28), other CSF leak (OR = 1.59; 95% CI = 1.28–1.98), altered mental status (OR = 1.46; 95% CI = 1.01–2.60), and postoperative fever (OR = 4.31; 95% CI = 1.14–16.23). There were no differences in hemorrhagic complications, ophthalmological complications, or bacterial meningitis. Postoperative complications resulted in longer hospitalization and increased healthcare costs. CONCLUSION: : Endoscopic approaches are increasingly being utilized to manage sellar pathologies relative to microsurgery. Postoperative complications occur in both techniques with higher incidences observed following endoscopic procedures.