J Neurol Surg B
DOI: 10.1055/s-0039-1700498
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma

1  Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
,
Agnish Nayak
1  Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
,
Mark Winder
2  Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
,
Benjamin Jonker
2  Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
3  Department of Neurosurgery, Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
4  Brain and Mind Centre, University of Sydney, Camperdown, Sydney, New South Wales, Australia
,
Raquel Alvarado
1  Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
,
Henry Barham
5  Sinus and Nasal Specialists of Louisiana, Louisiana, United States
,
Ann McCormack
6  Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia
7  St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
8  Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
,
Richard J. Harvey
1  Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
9  Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
› Author Affiliations
Further Information

Publication History

15 June 2019

13 September 2019

Publication Date:
21 October 2019 (online)

Abstract

Purpose Despite multidisciplinary care being commonly recommended, there remains limited evidence supporting its benefits in pituitary disease management. This study aimed to assess the impact of multidisciplinary care in pituitary surgery.

Methods A retrospective cohort study was performed comparing pituitary surgery outcomes among consecutive patients within a quaternary referral center in 5 years before and after introduction of a multidisciplinary team (MDT). Primary outcomes were endocrine (transient diabetes insipidus [DI], syndrome of inappropriate antidiuretic hormone [SIADH], and new hypopituitarism) and surgical (cerebrospinal fluid [CSF] leak, epistaxis, intracranial hemorrhage, and meningitis) complications, length of hospital stay, and intrasellar residual tumor.

Results 279 patients (89 pre-MDT vs. 190 post-MDT) were assessed (age 54 ± 17 years, 48% female). Nonfunctioning adenomas were most common (54%). In the post-MDT era, more clinically functioning tumors (42 vs. 28%, p = 0.03) were treated. Transient DI and SIADH occurred less often post-MDT (20 vs. 36%, p < 0.01 and 18 vs. 39%, p < 0.01), as well as new hypothyroidism (5 vs. 15, p < 0.01). Hospital stay was shorter post-MDT (5[3] vs. 7[5] days, p < 0.001) and intrasellar residuals were less common (8 vs. 35%, p < 0.001). Complications were more frequent pre-MDT independent of tumor size, hormone status, and surgical technique (odds ratio [OR] = 2.14 [1.05–4.32], p = 0.04).

Conclusion Outcomes of pituitary surgery improved after the introduction of an MDT. Pituitary MDTs may benefit both patients and the health system by improving quality of care and reducing hospital stays.

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