Risk Factors for Significant Postoperative Hemorrhage Following Pituitary Adenoma Resection: A Case–Control Study of 1,066 Surgeries

Objective: Postoperative hemorrhage is a rare but potentially severe complication after pituitary surgery. The risk factors for this complication are mostly unknown, and further knowledge would help define blood pressure targets and placement after surgery. Here we queried a large database of patients undergoing endonasal removal of pituitary adenomas and describe preoperative risks for significant postoperative hemorrhage (SPH).

Methods: A population of 1,066 patients undergoing endonasal (microscopic and endoscopic) surgery for pituitary adenoma resection at a single center was reviewed. SPH was defined as postoperative hematoma evident on imaging requiring return to the operating room. Patient and tumor characteristics were analyzed including basic demographics, pituitary apoplexy at presentation, tumor size and cavernous sinus invasion. Variables were assessed with uni- and multivariate logistic regression analysis. p-Values below 0.05 were considered significant.

Results: Ten patients (0.9%) were found to have SPH. Univariate analysis showed that these cases were significantly more likely to present with apoplexy (30.0% vs. 5.5%, p = 0.004), have larger adenomas (3.07 ± 0.60 vs. 1.79 ± 0.99 (cm), p < 0.001), and lower gross total resection rates (20.0 vs 61.7%, p = 0.019). A multivariate regression analysis ([Table 1]) showed that tumor size (OR: 1.94, 95% CI: 1.16–3.14, p = 0.008) and apoplexy at presentation (OR: 6.00, 95% CI: 1.15–24.82, p = 0.018) were significantly associated with higher odds of SPH.

Conclusions: Our data found that larger tumor size and presentation with apoplexy were associated with significant postoperative hemorrhage. Patients presenting with pituitary apoplexy are six times more likely to experience a significant postoperative hemorrhage and should be carefully monitored for it.

Table 1 Multivariate regression of variables found to have p < 0.10 on univariate analysis

Variable	Odds ratio (95% CI)	p-Value
Apoplexy at presentation	6.00 (1.15–24.82)	0.018
Tumor size	1.94 (1.16–3.14)	0.008
Cavernous sinus invasion	1.52 (0.36–7.11)	0.574
Number of prior pituitary surgeries	1.83 (0.84–3.67)	0.097
Gross total resection	0.42 (0.05–2.15)	0.330

Note: Bold rows indicate significance of p < 0.05. CI = confidence interval.

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Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2023