Effect of preoperative anemia on surgical outcomes in endonasal transsphenoidal surgery for pituitary adenoma: a matched-cohort study - Report - MDSpire
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Effect of preoperative anemia on surgical outcomes in endonasal transsphenoidal surgery for pituitary adenoma: a matched-cohort study
Impact of Preoperative Anemia on Outcomes in Endonasal Transsphenoidal Pituitary Surgery
Overview
This matched cohort study analyzed 10,345 patients undergoing endonasal transsphenoidal surgery for pituitary adenomas, revealing that preoperative anemia is associated with increased perioperative complications and worsened postoperative neuroendocrine dysfunction. Anemic patients had higher rates of meningitis, lumbar drain placement, early reoperation, diabetes insipidus, and electrolyte disturbances compared to non-anemic controls.
Background
Pituitary adenomas constitute about 15% of intracranial tumors and often require surgical resection when causing mass effect or optic apparatus compression. Preoperative anemia, defined by hemoglobin and hematocrit thresholds, is known to increase morbidity and mortality in various surgeries but its impact on pituitary surgery outcomes remains underexplored. Compromised vascular perfusion related to anemia may contribute to postoperative complications such as diabetes insipidus. Optimizing hematologic parameters preoperatively is critical to improve surgical outcomes.
Data Highlights
Outcome
Anemia Group (%)
Non-Anemia Group (%)
Odds Ratio (95% CI)
p-value
Postoperative Meningitis
3.4
1.7
2.01 (1.35–2.98)
<0.001
Lumbar Drain Placement
7.0
2.7
2.68 (1.97–3.62)
<0.001
Early Reoperation
5.0
2.9
1.76 (1.29–2.41)
<0.001
Postoperative CSF Leak
9.3
7.9
1.19 (0.97–1.47)
0.097
Postoperative Diabetes Insipidus
25.3
21.6
1.23 (1.07–1.41)
0.004
Desmopressin/Vasopressin Use
17.4
12.2
1.52 (1.28–1.79)
<0.011
SIADH/Hyponatremia
13.5
6.3
2.35 (1.90–2.89)
<0.001
Key Findings
Preoperative anemia was associated with a twofold increased risk of postoperative meningitis (OR 2.01; p < 0.001).
Anemic patients had significantly higher rates of lumbar drain placement (7.0% vs. 2.7%; OR 2.68; p < 0.001) and early reoperation (5.0% vs. 2.9%; OR 1.76; p < 0.001).
No statistically significant difference was observed in postoperative cerebrospinal fluid leak rates between groups (p = 0.097).
Neuroendocrine dysfunctions including postoperative diabetes insipidus were more frequent in anemic patients (25.3% vs. 21.6%; OR 1.23; p = 0.004).
Use of desmopressin/vasopressin and incidence of SIADH/hyponatremia were significantly higher in the anemia cohort (OR 1.52 and 2.35 respectively; both p < 0.011).
Preoperative identification and optimization of anemia in patients scheduled for endonasal transsphenoidal pituitary surgery may reduce the risk of infectious complications and neuroendocrine dysfunction. Enhanced perioperative monitoring and management strategies should be considered for anemic patients to mitigate risks of meningitis, reoperation, and hormonal imbalances. These findings support incorporating hematologic assessment into preoperative risk stratification protocols.
Conclusion
Preoperative anemia significantly impacts surgical and neuroendocrine outcomes following endonasal transsphenoidal resection of pituitary adenomas. Addressing anemia prior to surgery may improve patient prognosis and reduce postoperative complications.
References
TriNetX Research Network -- Data Source
STROCSS Guidelines 2020 -- Reporting Standards
Clinical Studies on Anemia and Surgical Outcomes -- Various Authors
