Changes in Pituitary Adenoma Patient Presentation and Outcomes During the COVID Pandemic at a Pituitary Center of Excellence

Background: The clinical care of patients with pituitary adenomas typically involves a multidisciplinary team working together to provide disease management, including pituitary surgery. The COVID-19 pandemic caused significant disruption to the surgical care of patients and, in many cases, dramatically reduced the ability to safely perform surgery. The aim of this study was to analyze the impact of the COVID-19 pandemic on endoscopic pituitary surgery at a pituitary center of excellence.

Methods: Patients were separated into a pre-COVID group (January 2015 to March 2020) and COVID group (March 2020 to September 2022). There were 314 patients in the pre-pandemic group and 178 patients in the COVID group. Preoperative variables collected included functional vs. nonfunctional, primary vs. recurrent, apoplexy, BMI, age, sex, risk assessment index (RAI) for preoperative frailty, lumbar drain placement, and preoperative prealbumin levels. Primary outcome variables included LOS and 30-day readmission. Univariate t-tests and multivariate regression tests were performed to compare variables before and during COVID.

Results: This chronological comparison study included 492 patients who had endoscopic endonasal surgery for pituitary adenomas. There was no significant difference in LOS and readmission rates between pre-COVID and COVID groups. Patients with a higher RAI frailty score and with a higher ASA score (3 or 4) were significantly increased during COVID (15 ± 10 pre-COVID vs. 20 ± 9 COVID, p < 0.001 and 72.0% pre-COVID vs. 81.9% COVID, p = 0.017). There were significantly more macroadenoma cases (87.6% pre-COVID vs. 94.4% COVID, p = 0.015) and additional extrasellar surgical approaches (45.2% pre-COVID vs. 61.2% COVID, p < 0.001) during COVID. Despite this, intra-operative CSF leak rate (36.6% pre-COVID vs. 24.4% COVID, p = 0.020) and nasoseptal flap reconstruction (53.4% pre-COVID vs. 35.2% COVID, p < 0.001) significantly decreased during COVID. Functional adenoma rate, apoplexy rate, lumbar drain usage, preoperative prealbumin levels, and discharge location remained similar between time periods.

Conclusion: At a single pituitary center of excellence, there were clear differences in the clinical characteristics of patients with surgically-resected pituitary adenomas during COVID. Patients who presented during the pandemic tended to be more frail and have more comorbidities. These patients were also more likely to present with larger adenomas and require additional expanded surgical approaches. Interestingly, despite the increased anatomical and clinical complexity of patients during COVID, the rate of intraoperative CSF-leak and nasoseptal flap use decreased, which could represent a bias or a learning curve. These findings suggest that COVID delayed time to presentation for patients leading to larger tumors, more extensive surgery, and older patients. Despite changes in clinical presentation and operative management, the length of stay and readmission rate remained stable during COVID, supporting the safety of this procedure during the recent pandemic.

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Artikel online veröffentlicht:
05. Februar 2024