Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations

Arman Jahangiri, Jeffrey Wagner, Sung Won Han, Corinna C. Zygourakis, Seunggu (Jude) Han, Mai T. Tran, Liane M. Miller, Maxwell W. Tom, Sandeep Kunwar, Lewis S. Blevins, MAnish K. Aghi

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Object. While transsphenoidal surgery is associated with low morbidity, the degree to which morbidity increases after reoperation remains unclear. The authors determined the morbidity associated with repeat versus initial transsphenoidal surgery after 1015 consecutive operations. Methods. The authors conducted a 5-year retrospective review of the first 916 patients undergoing transsphenoidal surgery at their institution after a pituitary center of expertise was established, and they analyzed morbidities. Results. The authors analyzed 907 initial and 108 repeat transsphenoidal surgeries performed in 916 patients (9 initial surgeries performed outside the authors' center were excluded). The most common diagnoses were endocrine inactive (30%) or active (36%) adenomas, Rathke's cleft cysts (10%), and craniopharyngioma (3%). Morbidity of initial surgery versus reoperation included diabetes insipidus ([DI] 16% vs 26%; p = 0.03), postoperative hyponatremia (20% vs 16%; p = 0.3), new postoperative hypopituitarism (5% vs 8%; p = 0.3), CSF leak requiring repair (1% vs 4%; p = 0.04), meningitis (0.4% vs 3%; p = 0.02), and length of stay ([LOS] 2.8 vs 4.5 days; p = 0.006). Of intraoperative parameters and postoperative morbidities, 1) some (use of lumbar drain and new postoperative hypopituitarism) did not increase with second or subsequent reoperations (p = 0.3-0.9); 2) some (DI and meningitis) increased upon second surgery (p = 0.02-0.04) but did not continue to increase for subsequent reoperations (p = 0.3-0.9); 3) some (LOS) increased upon second surgery and increased again for subsequent reoperations (p < 0.001); and 4) some (postoperative hyponatremia and CSF leak requiring repair) did not increase upon second surgery (p = 0.3) but went on to increase upon subsequent reoperations (p = 0.001-0.02). Multivariate analysis revealed that operation number, but not sex, age, pathology, radiation therapy, or lesion size, increased the risk of CSF leak, meningitis, and increased LOS. Separate analysis of initial versus repeat transsphenoidal surgery on the 2 most common benign pituitary lesions, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13% vs 35% [p = 0.001]; and CSF leak, 0.3% vs 9% [p = 0.0009]). Conclusions. Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.

Original languageEnglish (US)
Pages (from-to)67-74
Number of pages8
JournalJournal of neurosurgery
Volume121
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Reoperation
Morbidity
Diabetes Insipidus
Central Nervous System Cysts
Meningitis
Length of Stay
Hypopituitarism
Hyponatremia
Pituitary Neoplasms
Pituitary Diseases
Pathology
Craniopharyngioma
Adenoma
Radiotherapy
Multivariate Analysis
Incidence

Keywords

  • Morbidity
  • Oncology
  • Pituitary surgery
  • Reoperation
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Jahangiri, A., Wagner, J., Han, S. W., Zygourakis, C. C., Han, S. J., Tran, M. T., ... Aghi, MA. K. (2014). Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations. Journal of neurosurgery, 121(1), 67-74. https://doi.org/10.3171/2014.3.JNS131532

Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations. / Jahangiri, Arman; Wagner, Jeffrey; Han, Sung Won; Zygourakis, Corinna C.; Han, Seunggu (Jude); Tran, Mai T.; Miller, Liane M.; Tom, Maxwell W.; Kunwar, Sandeep; Blevins, Lewis S.; Aghi, MAnish K.

In: Journal of neurosurgery, Vol. 121, No. 1, 01.01.2014, p. 67-74.

Research output: Contribution to journalArticle

Jahangiri, A, Wagner, J, Han, SW, Zygourakis, CC, Han, SJ, Tran, MT, Miller, LM, Tom, MW, Kunwar, S, Blevins, LS & Aghi, MAK 2014, 'Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations', Journal of neurosurgery, vol. 121, no. 1, pp. 67-74. https://doi.org/10.3171/2014.3.JNS131532
Jahangiri, Arman ; Wagner, Jeffrey ; Han, Sung Won ; Zygourakis, Corinna C. ; Han, Seunggu (Jude) ; Tran, Mai T. ; Miller, Liane M. ; Tom, Maxwell W. ; Kunwar, Sandeep ; Blevins, Lewis S. ; Aghi, MAnish K. / Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations. In: Journal of neurosurgery. 2014 ; Vol. 121, No. 1. pp. 67-74.
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abstract = "Object. While transsphenoidal surgery is associated with low morbidity, the degree to which morbidity increases after reoperation remains unclear. The authors determined the morbidity associated with repeat versus initial transsphenoidal surgery after 1015 consecutive operations. Methods. The authors conducted a 5-year retrospective review of the first 916 patients undergoing transsphenoidal surgery at their institution after a pituitary center of expertise was established, and they analyzed morbidities. Results. The authors analyzed 907 initial and 108 repeat transsphenoidal surgeries performed in 916 patients (9 initial surgeries performed outside the authors' center were excluded). The most common diagnoses were endocrine inactive (30{\%}) or active (36{\%}) adenomas, Rathke's cleft cysts (10{\%}), and craniopharyngioma (3{\%}). Morbidity of initial surgery versus reoperation included diabetes insipidus ([DI] 16{\%} vs 26{\%}; p = 0.03), postoperative hyponatremia (20{\%} vs 16{\%}; p = 0.3), new postoperative hypopituitarism (5{\%} vs 8{\%}; p = 0.3), CSF leak requiring repair (1{\%} vs 4{\%}; p = 0.04), meningitis (0.4{\%} vs 3{\%}; p = 0.02), and length of stay ([LOS] 2.8 vs 4.5 days; p = 0.006). Of intraoperative parameters and postoperative morbidities, 1) some (use of lumbar drain and new postoperative hypopituitarism) did not increase with second or subsequent reoperations (p = 0.3-0.9); 2) some (DI and meningitis) increased upon second surgery (p = 0.02-0.04) but did not continue to increase for subsequent reoperations (p = 0.3-0.9); 3) some (LOS) increased upon second surgery and increased again for subsequent reoperations (p < 0.001); and 4) some (postoperative hyponatremia and CSF leak requiring repair) did not increase upon second surgery (p = 0.3) but went on to increase upon subsequent reoperations (p = 0.001-0.02). Multivariate analysis revealed that operation number, but not sex, age, pathology, radiation therapy, or lesion size, increased the risk of CSF leak, meningitis, and increased LOS. Separate analysis of initial versus repeat transsphenoidal surgery on the 2 most common benign pituitary lesions, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13{\%} vs 35{\%} [p = 0.001]; and CSF leak, 0.3{\%} vs 9{\%} [p = 0.0009]). Conclusions. Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.",
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author = "Arman Jahangiri and Jeffrey Wagner and Han, {Sung Won} and Zygourakis, {Corinna C.} and Han, {Seunggu (Jude)} and Tran, {Mai T.} and Miller, {Liane M.} and Tom, {Maxwell W.} and Sandeep Kunwar and Blevins, {Lewis S.} and Aghi, {MAnish K.}",
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T1 - Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations

AU - Jahangiri, Arman

AU - Wagner, Jeffrey

AU - Han, Sung Won

AU - Zygourakis, Corinna C.

AU - Han, Seunggu (Jude)

AU - Tran, Mai T.

AU - Miller, Liane M.

AU - Tom, Maxwell W.

AU - Kunwar, Sandeep

AU - Blevins, Lewis S.

AU - Aghi, MAnish K.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Object. While transsphenoidal surgery is associated with low morbidity, the degree to which morbidity increases after reoperation remains unclear. The authors determined the morbidity associated with repeat versus initial transsphenoidal surgery after 1015 consecutive operations. Methods. The authors conducted a 5-year retrospective review of the first 916 patients undergoing transsphenoidal surgery at their institution after a pituitary center of expertise was established, and they analyzed morbidities. Results. The authors analyzed 907 initial and 108 repeat transsphenoidal surgeries performed in 916 patients (9 initial surgeries performed outside the authors' center were excluded). The most common diagnoses were endocrine inactive (30%) or active (36%) adenomas, Rathke's cleft cysts (10%), and craniopharyngioma (3%). Morbidity of initial surgery versus reoperation included diabetes insipidus ([DI] 16% vs 26%; p = 0.03), postoperative hyponatremia (20% vs 16%; p = 0.3), new postoperative hypopituitarism (5% vs 8%; p = 0.3), CSF leak requiring repair (1% vs 4%; p = 0.04), meningitis (0.4% vs 3%; p = 0.02), and length of stay ([LOS] 2.8 vs 4.5 days; p = 0.006). Of intraoperative parameters and postoperative morbidities, 1) some (use of lumbar drain and new postoperative hypopituitarism) did not increase with second or subsequent reoperations (p = 0.3-0.9); 2) some (DI and meningitis) increased upon second surgery (p = 0.02-0.04) but did not continue to increase for subsequent reoperations (p = 0.3-0.9); 3) some (LOS) increased upon second surgery and increased again for subsequent reoperations (p < 0.001); and 4) some (postoperative hyponatremia and CSF leak requiring repair) did not increase upon second surgery (p = 0.3) but went on to increase upon subsequent reoperations (p = 0.001-0.02). Multivariate analysis revealed that operation number, but not sex, age, pathology, radiation therapy, or lesion size, increased the risk of CSF leak, meningitis, and increased LOS. Separate analysis of initial versus repeat transsphenoidal surgery on the 2 most common benign pituitary lesions, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13% vs 35% [p = 0.001]; and CSF leak, 0.3% vs 9% [p = 0.0009]). Conclusions. Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.

AB - Object. While transsphenoidal surgery is associated with low morbidity, the degree to which morbidity increases after reoperation remains unclear. The authors determined the morbidity associated with repeat versus initial transsphenoidal surgery after 1015 consecutive operations. Methods. The authors conducted a 5-year retrospective review of the first 916 patients undergoing transsphenoidal surgery at their institution after a pituitary center of expertise was established, and they analyzed morbidities. Results. The authors analyzed 907 initial and 108 repeat transsphenoidal surgeries performed in 916 patients (9 initial surgeries performed outside the authors' center were excluded). The most common diagnoses were endocrine inactive (30%) or active (36%) adenomas, Rathke's cleft cysts (10%), and craniopharyngioma (3%). Morbidity of initial surgery versus reoperation included diabetes insipidus ([DI] 16% vs 26%; p = 0.03), postoperative hyponatremia (20% vs 16%; p = 0.3), new postoperative hypopituitarism (5% vs 8%; p = 0.3), CSF leak requiring repair (1% vs 4%; p = 0.04), meningitis (0.4% vs 3%; p = 0.02), and length of stay ([LOS] 2.8 vs 4.5 days; p = 0.006). Of intraoperative parameters and postoperative morbidities, 1) some (use of lumbar drain and new postoperative hypopituitarism) did not increase with second or subsequent reoperations (p = 0.3-0.9); 2) some (DI and meningitis) increased upon second surgery (p = 0.02-0.04) but did not continue to increase for subsequent reoperations (p = 0.3-0.9); 3) some (LOS) increased upon second surgery and increased again for subsequent reoperations (p < 0.001); and 4) some (postoperative hyponatremia and CSF leak requiring repair) did not increase upon second surgery (p = 0.3) but went on to increase upon subsequent reoperations (p = 0.001-0.02). Multivariate analysis revealed that operation number, but not sex, age, pathology, radiation therapy, or lesion size, increased the risk of CSF leak, meningitis, and increased LOS. Separate analysis of initial versus repeat transsphenoidal surgery on the 2 most common benign pituitary lesions, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13% vs 35% [p = 0.001]; and CSF leak, 0.3% vs 9% [p = 0.0009]). Conclusions. Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.

KW - Morbidity

KW - Oncology

KW - Pituitary surgery

KW - Reoperation

KW - Transsphenoidal surgery

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