Clinical characteristics and temporal trends of lumbar drain use in minimally invasive resection of pituitary neoplasms.

Abstract

Objectives: Appropriate scenarios of lumbar drain (LD) use in endonasal skull base surgery is an active area of investigation. However, existing data is limited. The purpose of this study is to evaluate the robustness of the NSQIP database to characterize morbidity and complications associated with LD usage concurrent to minimally invasive resection of pituitary tumors.

Methods: A cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program database was used to query patients undergoing transnasal resection of pituitary tumor. Patients were stratified by concurrent perioperative use of LD and outcomes were compared.

Results: A total of 1714 patients underwent minimally invasive endonasal (microscopic or endoscopic) pituitary tumor resection, of which LD was concurrently placed in 98 (5.7%) cases. Operative time was significantly longer for patients who had LD placed compared to those without (176.5 min (IQR 114.8-229.5) vs. 137 min [IQR 100-185]), (p < 0.001) with a significantly longer length of stay (5 days [IQR 4-6] vs. 3 days [IQR 2-5]), (p < 0.001). Multivariate regression demonstrated LD placement was an independent predictor of postoperative medical complication (OR 2.41, 95% CI 1.15-5.03, p = 0.020) and unplanned readmission (OR 2.06, 95% CI 1.02-4.16, p = 0.044), but not CSF leak (OR 2.30, 95% CI 0.51-10.26; p = 0.276). Temporal analysis during the study period demonstrated a decrease in LD use from 8% to 5% (R ² = 0.60; p = 0.025).

Conclusions: The NSQIP database provides a large patient population for examining LD use in endoscopic pituitary adenoma resection. LD use for minimally invasive pituitary surgery is associated with postoperative medical complications and unplanned readmissions, with no apparent impact on reconstructive outcomes, and there is overall decreasing usage. Clinical judgment should be exercised in selecting appropriate scenarios for use.