Perioperative Variables and Costs Associated with Early Remission in Cushing's Patients with Micro- and Macroadenomas

Cushing's disease is a condition of excess adrenocorticotropic hormone release from the anterior pituitary and represents the most common form of endogenous glucocorticoid excess. This population also faces an increased prevalence of several conditions such as type 2 diabetes, hypertension, and osteoporosis, as well as a hypercoagulable state. This increases the risk for thromboembolic events in this population, particularly in hospitalized patients who are already at increased risk for these events. The purpose of this study is to characterize patients undergoing perioperative prophylaxis for thromboembolism at the University of Michigan. We retrospectively analyzed data on 80 adult patients with Cushing's disease who had undergone pituitary adenoma resection at the University of Michigan between April 2011 and May 2020. Patients received three different courses of perioperative prophylactic treatment: (1) post-op anticoagulant regimen (i.e., subcutaneous heparin 5,000 U TID), (2) intraoperative heparin (5,000 U) in addition to post-op heparin TID, and (3) intraoperative heparin (5,000 U) in addition to post-op heparin (5,000 U TID) and discharged on an anticoagulation regimen (i.e., subcutaneous Levonox 40 mg). The mean age at the time of adenoma resection was 44 ± 16.2 years old (84% female). Our patients experienced a total of 30 thromboembolic events among 14 patients, 5 (17%) of which occurred following surgery. 61% of patients received postoperative heparin treatment (Group 1), 23% of patients received intraoperative and postoperative heparin (Group 2), and 16% of patients received intraoperative and postoperative heparin, in addition to being discharged on Levonox (Group 3). The median length of stay for all three groups was 4 days; however, patients in group 1 had a higher rate of readmissions (9 readmissions) compared to 1 in group 2 and 2 in group 3. Further, median hospital charges for patients were $60,132 for group 1, $77,637 for group 2, and $42,387 for group 3. The hypercoagulable state in Cushing's disease increases the risk of thromboembolic events in Cushing's patients compared to the general population. Currently, there are no guidelines on prophylactic treatment for Cushing's disease patients. As such, finding effective prophylactic treatments that decrease thromboembolic events, as well as total readmissions and costs for patients can help provide a better quality of life for patients with Cushing's disease. Future directions for this study are to further evaluate the efficacy of our prophylactic treatment in this patient population.

Publication History

Article published online:
12 February 2021