Operative considerations for resection of pituitary adenoma in patients with sickle cell disease: A retrospective analysis of 19,653 patients.

Abstract

Background: Sickle cell disease (SCD) is a hemoglobinopathy that affects over 30 million individuals worldwide. When significant "sickling" occurs, blood flow to specific organs can be impaired, resulting in ischemia or infarction. This can be problematic during intracranial surgery, in which low systemic circulatory volume due to significant blood loss can lead to intracranial hypotension. Using a multivariable modeling approach, we gathered a large patient dataset through a nationally representative database to inform future neurosurgical management of patients with concurrent SCD and pituitary adenoma.

Methods: We queried the Healthcare Cost and Utilization Project Nationwide Readmissions Database and implemented discharge weighting to identify a cohort of SCD patients who had undergone surgical resection of pituitary adenoma between 2015 and 2016. Variables investigated included patient age, sex, length of stay, postoperative complications and outcomes, payment methods, and median income, among several others.

Results: Retrospective analysis identified 19,612 non-sickle cell patients (NSCP) and 41 SCD patients. Complication profiles for the SCD cohort demonstrated significantly higher rates of postoperative pulmonary embolism (P = 0.042) and pneumonia (P = 0.005) compared to those of the NSCP cohort. In addition, the SCD cohort trended toward higher rates of readmission (15.25% vs. 9.76%) and deep vein thrombosis, although neither achieved statistical significance (P = 0.45 and 0.07, respectively).

Conclusion: SCD is a severe disorder that affects many individuals worldwide and represents a significant risk factor for complications and adverse outcomes in pituitary adenoma surgery. Further research is needed to explore SCD as a risk factor in pituitary surgery and the role it may play in perioperative complications.