Volume 127, Issue 7 pp. 1543-1550

Cranial Base

Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?

Curtis Hanba BS,

Curtis Hanba BS

Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A

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Peter F. Svider MD,

Corresponding Author

Peter F. Svider MD

[email protected]

Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A

Send correspondence to Peter Svider, MD, Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201. E-mail: [email protected]Search for more papers by this author

Jeffrey T. Jacob MD,

Jeffrey T. Jacob MD

Michigan Head and Spine Institute, Novi, Michigan, U.S.A

William Beaumont Health System, Royal Oak, Michigan, U.S.A

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Murali Guthikonda MD, FAANS, FACS,

Murali Guthikonda MD, FAANS, FACS

Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A

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James K. Liu MD, FACS,

James K. Liu MD, FACS

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.

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Jean Anderson Eloy MD FACS,

Jean Anderson Eloy MD FACS

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.

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Adam J. Folbe MD,

Adam J. Folbe MD

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

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Curtis Hanba BS,

Curtis Hanba BS

Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A

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Peter F. Svider MD,

Corresponding Author

Peter F. Svider MD

[email protected]

Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A

Jeffrey T. Jacob MD,

Jeffrey T. Jacob MD

Michigan Head and Spine Institute, Novi, Michigan, U.S.A

William Beaumont Health System, Royal Oak, Michigan, U.S.A

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Murali Guthikonda MD, FAANS, FACS,

Murali Guthikonda MD, FAANS, FACS

Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A

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James K. Liu MD, FACS,

James K. Liu MD, FACS

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.

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Jean Anderson Eloy MD FACS,

Jean Anderson Eloy MD FACS

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.

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Adam J. Folbe MD,

Adam J. Folbe MD

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

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First published: 23 December 2016

https://doi.org/10.1002/lary.26364

Citations: 3

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives/Hypothesis

To explore the relationship between lower airway disease and postoperative cerebrospinal fluid (CSF) rhinorrhea among patients undergoing pituitary surgery

Study Design

Retrospective review.

Methods

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.

Results

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.

Conclusions

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.

Level of Evidence

2c. Laryngoscope, 127:1543–1550, 2017

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Volume127, Issue7

July 2017

Pages 1543-1550

Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Lower airway disease and pituitary surgery: Is there an association with postoperative cerebrospinal fluid leak?

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

Information