Smoking Cessation Equilibrates Risk of Perioperative Complications following Endoscopic Endonasal Resection of Pituitary Neuroendocrine Tumors

Background: Modifiable risk factors represent patient characteristics that offer the opportunity to decrease surgical-associated complications allowing for shorter and less-expensive hospital stays, decreased burden on hospital systems, and a more positive perioperative experience. Modifiable risk factors including obesity, smoking, and presence of obstructive sleep apnea are positively associated with perioperative complications following endoscopic skull base surgery. However, association of smoking cessation with perioperative risk following endoscopic endonasal resection of pituitary neuroendocrine tumors (PitNETs) remains largely unknown.

Objective: To evaluate the effect of the modifiable risk factors (BMI and smoking cessation) on perioperative complications following endoscopic endonasal resection of pituitary neuroendocrine tumors.

Methods: A single-center, multisurgeon retrospective cohort study of patients undergoing endoscopic endonasal transsphenoidal surgery for resection of PitNETs between 2011 and 2024 at the University of Washington was performed. Review of the medical record was performed to identify BMI and smoking status at the time of surgery. Patients were stratified into those who never smoked and those with a past history of smoking. Due to small sample size limiting meaningful analysis, active smokers were excluded from this analysis. BMI was stratified by BMI of ≤25.0, 25.1 ≤ 30.0, 30.1 ≤ 35.0, 35.1 ≤ 40.0, and >40.1. The clinical record was reviewed for patient demographics, and preoperative tumor and surgical characteristics. Outcomes including length of stay, readmission rate, symptomatic hyponatremia requiring readmission, and intraoperative and postoperative CSF leak were measured and compared across smoking and BMI cohorts.

Results: A total of 883 patients were identified for study, and after exclusion for incomplete data and active smoking status, a total of 764 patients remained for study. The average age was 50.9 ± 17.3 years and 54.1% of patients were women. A total of 628 patients (82.2%) were categorized as never smokers, and 136 (17.8%) were categorized as prior smokers. There was no difference in length of stay (p = 0.592), 30-day readmission rate for any reason (p = 0.881), symptomatic hyponatremia requiring readmission (p = 0.933), intraoperative CSF leak (p = 0.216), and postoperative CSF leak (p = 0.890) between never and past smokers. In a single BMI stratum (≤25.0), postoperative CSF leak rate was significantly higher in past smokers as compared to never smokers (21.0 vs. 5.4%, p = 0.031) and as compared to other BMI strata (p = 0.026), suggesting a likely component of frailty.

Conclusion: The risk of perioperative complications for patients undergoing endoscopic resection of PitNETs is multifactorial. We identify that smoking cessation equilibrates the risk of perioperative complications as compared to never smokers. Optimization of modifiable risk factors in nonemergency surgery may offer an improvement in surgical outcomes. Future studies would benefit from multi-institutional collaborations to identify any increased risk of active smoking on perioperative outcomes.

 

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Artikel online veröffentlicht:
05. Februar 2024