Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery

Rezende, Gustavo Lara; Neto, Oswaldo Ribeiro Marquez; Kückelhaus, Selma Aparecida Souza

doi:10.1016/j.bjorl.2020.02.006

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…That study and another article authored by Rezende et al. showed that nasal crusting was apparent for a mean of 3–4 months following ESBS 95 . Reconstruction methods significantly affect the amount of time required for crusting to resolve.…”

Section: Resultsmentioning

confidence: 78%

“…That study and another article authored by Rezende et al showed that nasal crusting was apparent for a mean of 3-4 months following ESBS. 95 Reconstruction methods significantly affect the amount of time required for crusting to resolve. While neither study showed evidence to support that nasal debridement is necessary for this duration of time, surgeons may be inclined to consider regular debridement until this point in the postoperative course is reached.…”

Section: Nasal Debridementmentioning

confidence: 99%

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Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

Abiri

Patel

Nguyen

et al. 2022

Int Forum Allergy Rhinol

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Background Postoperative management strategies for endoscopic skull base surgery (ESBS) vary widely because of limited evidence‐based guidance. Methods The PubMed, EMBASE, and Cochrane databases were systematically reviewed from January 1990 through February 2022 to examine 18 postoperative considerations for ESBS. Nonhuman studies, articles written in a language other than English, and case reports were excluded. Studies were assessed for levels of evidence, and each topic's aggregate grade of evidence was evaluated. Results A total of 74 studies reporting on 18 postoperative practices were reviewed. Postoperative pain management, prophylactic antibiotics, and lumbar drain use had the highest grades of evidence (B). The literature currently lacks high quality evidence for a majority of the reviewed ESBS precautions. There were no relevant studies to address postoperative urinary catheter use and medical intracranial pressure reduction. Conclusion The evidence for postoperative ESBS precautions is heterogeneous, scarce, and generally of low quality. Although this review identified the best evidence available in the literature, it suggests the urgent need for more robust evidence. Therefore, additional high‐quality studies are needed in order to devise optimal postoperative ESBS protocols.

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Section: Resultsmentioning

confidence: 78%

Section: Nasal Debridementmentioning

confidence: 99%

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

Abiri

Patel

Nguyen

et al. 2022

Int Forum Allergy Rhinol

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“…4 Despite becoming the standard of care at most institutions with high rates of positive outcomes, 5 the postoperative period after endoscopic TSH can be complicated by fluid imbalance, CSF leaks, infection, and additional intracranial morbidities. [6][7][8] Such complications, which can arise for a variety of risk factors not limited to the procedure that 9,10 result in returns to the operating room, prolonged hospital stays, and unplanned readmissions. 5,11,12 While the carcinogenic effects of tobacco smoke have been well-characterized, smoking tobacco has also been identified as a significant risk for poor healing and the need for reoperation after head and neck surgery.…”

Section: Introductionmentioning

confidence: 99%

A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma

Min

Zhang

et al. 2023

J Neurol Surg B Skull Base

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Objectives: This study seeks to comprehensively analyze the impact of smoking history on outcomes after endoscopic transsphenoidal hypophysectomy (TSH) for pituitary adenoma. Design: Retrospective. Setting: Tertiary care center. Participants: 398 adult patients undergoing TSH for a pituitary adenoma. Main outcome measures: Clinical and tumor characteristics and operative factors were collected. Patients were categorized as never, former, or active smokers, and the pack-years of smoking history was collected. Years since cessation of smoking was obtained for former smokers. Specific outcomes included post-operative CSF leak, length of hospitalization, 30-day return to the operating room, and 30-day readmission. Smoking history details were comprehensively analyzed for association with outcomes. Results: Any history of smoking tobacco was associated with return to the operating room (OR=2.67, 95%CI: 1.05–6.76, p=0.039), which was for persistent CSF leak in 58.3%. Among patients with post-operative CSF leak, any history of smoking was associated with need for return to the operating room to repair the CSF leak (OR=5.25, 95%CI: 1.07–25.79, p=0.041). Pack-years of smoking was positively associated with a return to the operating room (OR=1.03, 95%CI: 1.01–1.06, p=0.048). In all multivariable models, all negative outcomes were significantly associated with the covariate occurrence of intra-operative CSF leak. Conclusion: This is the first study to show smoking may have a negative impact on healing of CSF leak repairs after TSH, requiring a return to the operating room. This effect appears to be dose-dependent on the smoking history. Secondarily, intra-operative CSF leak as covariate in multivariable models was significantly associated with all negative outcomes.

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“…4,5 Identifying predisposing risk factors for adverse outcomes may be useful in avoiding complications and decreasing morbidity rates. [6][7][8][9][10] Previously proposed risk factors of complications after endoscopic skull base surgery include advanced age, size, history of prior surgery, preoperative radiation, elevated intracranial pressure, body mass index (BMI), blood urea nitrogen, and white blood cell counts. 1,11,12 Age-dependent differences in these factors yield unique patient risk profiles.…”

Section: Introductionmentioning

confidence: 99%

Anterior Skull Base Outcomes and Complications: A Propensity Score–Matched Evaluation of Age and Frailty as Measured by mFI-5 from the ACS-NSQIP Database

Bauer

Findlay

Khan

et al. 2023

Indian Journal of Neurosurgery

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Background Frailty is increasingly recognized as a predictor of surgical outcomes; however, its utility in anterior cranial fossa (ACF) surgery remains unclear. We analyzed whether age and frailty are independent predictors of outcomes after ACF surgery using a retrospective cohort study. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried, by Current Procedural Terminology codes, for ACF procedures in 2005 to 2020. Cases included open approaches, endoscopic approaches, and all tumor types except for pituitary adenoma. A propensity score–matched data set was analyzed via multiple logistic regression. Results Unmatched multivariate analysis of ACF cases demonstrated that severe frailty (modified 5-item frailty index [mFI-5] ≥ 3) was independently associated with having any (odds ratio [OR] = 3.67) and minor (OR = 5.00) complications (both p < 0.001). Analysis of individual mFI-5 components demonstrated poor functional status was significantly associated with any (OR = 3.39), major (OR = 3.59), and minor (OR = 3.14) complications (all p < 0.001). After propensity score matching, only age was modestly impactful on minor complications (OR = 1.02) and extended length of stay (eLOS) (OR = 1.02) (p < 0.001). Frailty did not maintain its predictive ability after matching. Nonindependent functional status, as a subcomponent of mFI maintained significant predictive ability for any (OR = 4.94), major (OR = 4.68), and minor (OR = 4.80) complications and eLOS (OR = 2.92) (all p < 0.001). Conclusion After propensity score matching, age demonstrated a greater ability to predict postoperative complications in ACF surgery than frailty. Rather than age or frailty, functional status served as a better outcome predictor and potential guide for patient counseling. Further validation of these findings in multicenter or disease-specific studies is warranted as well as aims to preoperatively improve functional status in ACF surgery.

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Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery

Cited by 6 publications

References 20 publications

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma

Anterior Skull Base Outcomes and Complications: A Propensity Score–Matched Evaluation of Age and Frailty as Measured by mFI-5 from the ACS-NSQIP Database

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