COVID-19 Pandemic Significant Effect on Transsphenoidal Pituitary Resection Surgery (TSPR) at Inova Health System: An Institutional Experience

Introduction: In the wake of both the unprecedented nationwide ban on elective surgery during the COVID-19 pandemic and the increased mortality of otolaryngologists and neurosurgeons during this same time period, concern regarding the timing and safety of neurosurgical intervention for sellar-based pathology has been raised within both the neurosurgical and otolaryngology communities.

Methods: A retrospective chart review was performed on all patients who underwent operative intervention for sellar-based pathology from March 12 to July 1 for both 2019 and 2020. Dates were chosen to align with the Virginia State of Emergency on March 12 and the multiphase reopening of the public which lasted until July 1. Primary endpoints studied for comparison included case volume, median time to surgery, and COVID-related mortality.

Results: In total, a 26.6% decrease in overall surgical case volume occurred in comparison to the previous year. A statistically significant decrease in frequency of endonasal surgery was seen from 20 in 2019 to 6 in 2020 (p = 0.04). While median time to surgery for pituitary adenomas was unchanged from the previous year (26 days), this data does not take into account six patients who electively postponed treatment due to fear of receiving medical care during the pandemic. Among 2,795 COVID-19 patients treated in our institution, only one patient had a pituitary tumor. Here, treatment was delayed by 81 days. For emergent cases, such as pituitary apoplexy, surgeons increased utilization of the microscope as a means to reduce the number of personnel exposed. Finally, our practice had no COVID-related mortality for patients undergoing sellar-based surgery.

Conclusion: The COVID-19 pandemic did not delay time to treatment for emergent presentations of vision loss or pituitary apoplexy. In these instances, our department followed strict institutional policy regarding use of proper PPE, as well as minimization of hospital personnel exposure. On an outpatient basis, the pandemic did cause a noticeable delay in time to treatment; however, patients' outcomes were unaffected. Close patient monitoring was achieved via utilization of telemedicine to trend hormone levels and assess development of related symptoms. Finally, decreases in overall case volume are likely due to ongoing cultural avoidance of seeking medical care, while deferment of endonasal surgery may be attributed to a concern for greater mortality for endonasal procedures.

Publication History

Article published online:
12 February 2021