Long-Term Quality of Life Outcomes in Minimally Invasive Pituitary Surgery

Background and Methods: Endoscopic endonasal minimally invasive pituitary surgery (MIPS) has proven to be safe and efficacious. Although some data exist on short-term quality of life (QOL) improvement, virtually no data exist on long-term QOL outcomes after MIPS. Our hypothesis is that patients will report no long-term change in sinus disability after undergoing MIPS. In this study we retrospectively reviewed patients who underwent minimally invasive pituitary surgery (MIPS) from 2002–2009. Rhinosinusitis Disability Index (RSDI) scores and patient demographics were recorded. Patient responses were stratified as <1 month, <2 months, <6 months, <1 year, or >1 year after surgery. Pre- and postoperative mean RSDI scores and the mean absolute change in RSDI were calculated with 95% confidence intervals.

Results: The postoperative RSDI surveys were filled out an average of 24 (range, 0–92) months after surgery by 50 patients. Based on RSDI mean scores, there was no significant difference in QOL scores between <1 year postoperative patients (n = 24) and >1 year postoperative patients (n = 26) (P = 0.21). Mean differences in RSDI scores decreased dramatically in the 1–2 month period to −22 (n = 3) before becoming positive and approaching 0 at greater than 3 years (n = 13). The RSDI score ranges also narrowed during the time course, as <1 year postoperative patients ranged from −64 to +65, >1 year postoperative patients ranged from −53 to +18, and the >3 years cohort ranged only from −20 to +18. There was no statistically significant difference between total pre- and postoperative RSDI scores (P = 0.84). A direct comparison with an expanded (beyond the sella) endonasal approach prospective cohort is presented and discussed.

Discussion: These data show that MIPS with appropriate postoperative care results in little or no long-term (24 months mean) sinonasal QOL defects after surgery. Although patients may experience QOL defects and high variance in the short term, eventual QOL outcomes should increase and approach similar or better QOL outcomes in the long term. Retrospective design, small sample size, recall bias due to length of time after surgery, and lack of a non-intervention control group may contribute to limitations for this study.