The Impact of Extended Procedure Duration on Nasal Morbidity after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Macroadenomas

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Abstract Nasal mucosa is susceptible to injury during endoscopic endonasal transsphenoidal resection of pituitary macroadenomas. Prolonged operative times may lead to increased instrumentation-induced injury to nasal mucosa. Influence of operative time on sinonasal morbidity has not been reported previously. Our objective is to determine preoperative drivers extending operative time and the impact of prolonged endoscopic endonasal transsphenoidal resection on nasal morbidity as measured by postoperative SNOT-22 questionnaire. SNOT-22 scores were collected at each rhinology visit and intraoperative OR start and stop timestamps as recorded by nursing staff were extracted from the record. Cases of endoscopic endonasal transsphenoidal pituitary adenoma resection at a tertiary care center were identified. Multivariable regression was done analyzing factors influencing SNOT-22 scores and surgical time. The study included 222 patients. Median preoperative SNOT-22 score was 12.5 (IQR 4.00, 24.25) and median postoperative SNOT-22 score was 9 (IQR 2.00, 19.25), indicating overall improvement at 6 months. Median procedure duration was 200.4 minutes (IQR 164, 249). Multivariable regression of SNOT-22 showed only history of sinus surgery caused increased sinonasal morbidity (p = 0.05). Factors including tumor size (p = 0.01), surgical approach (p = 0.01), and reconstruction technique (p = 0.01) most significantly increased operative time. Only a history of prior sinus surgery was associated with increased nasal morbidity. Tumor size, functional tumors, surgical approach, reconstructive technique, and subtotal resection all prolonged operative time. Surgeons should consider counseling patients meeting these criteria on potential risk of increased morbidity and increased operative time with endoscopic endonasal transsphenoidal resection.

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