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

Susie Min; Grace Zhang; Alex Hu; Gabrielle T. Petito; Siddhant H. Tripathi; Geet Shukla; Adithya Kumar; Sanjit Shah; Katie M. Phillips; Jonathan A. Forbes; Mario Zuccarello; Norberto O. Andaluz; Ahmad R. Sedaghat

doi:10.1055/a-2043-0263

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2024; 85(03): 255-260
DOI: 10.1055/a-2043-0263

Original Article

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

Authors

Susie Min

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Grace Zhang

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Alex Hu

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Gabrielle T. Petito

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Siddhant H. Tripathi

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Geet Shukla

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Adithya Kumar

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Sanjit Shah

²Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Katie M. Phillips

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Jonathan A. Forbes

²Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Mario Zuccarello

²Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Norberto O. Andaluz

²Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Ahmad R. Sedaghat

¹Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States

Abstract

Objectives This study seeks to comprehensively analyze the impact of smoking history on outcomes after endoscopic transsphenoidal hypophysectomy (TSH) for pituitary adenoma.

Design This was a retrospective study.

Setting This study was done at the tertiary care center.

Participants Three hundred and ninety-eight 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 postoperative cerebrospinal fluid (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 (odds ratio [OR] = 2.67, 95% confidence interval [CI]: 1.05–6.76, p = 0.039), which was for persistent CSF leak in 58.3%. Among patients with postoperative 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 intraoperative 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, intraoperative CSF leak as covariate in multivariable models was significantly associated with all negative outcomes.

Keywords

smoking - transsphenoidal hypophysectomy - pituitary adenoma - complications - cerebrospinal fluid leak - skull base repair - return to the operating room

Full Text

References

References
1 Larkin S, Ansorge O. Pathology and pathogenesis of pituitary adenomas and other sellar lesions. In: Feingold KR, Anawalt B, Blackman MR. et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000
2 Li A, Liu W, Cao P, Zheng Y, Bu Z, Zhou T. Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary adenoma: a systematic review and meta-analysis. World Neurosurg 2017; 101: 236-246
3 Jandali D, Shearer S, Byrne R, Papagiannopoulos P, Tajudeen BA, Batra PS. Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar grafting. Am J Otolaryngol 2020; 41 (02) 102306
4 Møller MW, Andersen MS, Glintborg D. et al. Endoscopic vs. microscopic transsphenoidal pituitary surgery: a single centre study. Sci Rep 2020; 10 (01) 21942
5 Krings JG, Kallogjeri D, Wineland A, Nepple KG, Piccirillo JF, Getz AE. Complications following primary and revision transsphenoidal surgeries for pituitary tumors. Laryngoscope 2015; 125 (02) 311-317
6 Shay A, Sturgis M, Ritz EM. et al. Prior smoking and nasoseptal flap usage adversely impact quality of life and healing after endoscopic pituitary surgery. Neurosurg Focus 2020; 48 (06) E17
7 Rezende GL, Neto ORM, Kückelhaus SAS. Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery. Rev Bras Otorrinolaringol (Engl Ed) 2021; 87 (06) 689-694
8 Harrow BR, Batra PS. Sinonasal quality of life outcomes after minimally invasive resection of sinonasal and skull-base tumors. Int Forum Allergy Rhinol 2013; 3 (12) 1013-1020
9 Schoemaker MJ, Swerdlow AJ. Risk factors for pituitary tumors: a case-control study. Cancer Epidemiol Biomarkers Prev 2009; 18 (05) 1492-1500
10 Al-Qurayshi Z, Bennion DM, Greenlee JDW, Graham SM. Endoscopic pituitary surgery: national database review. Head Neck 2022; 44 (12) 2678-2685
11 Sukys JM, Jiang R, Manes RP. Assessing risk of severe complications after endoscopic transnasal transsphenoidal surgery: a comparison of frailty, American Society of Anesthesiologists, and comorbidity scores. J Neurol Surg B Skull Base 2021; 83 (05) 536-547
12 Stefanidis P, Kyriakopoulos G, Athanasouli F. et al. Postoperative complications after endoscope-assisted transsphenoidal surgery for pituitary adenomas: a case series, systematic review, and meta-analysis of the literature. Hormones (Athens) 2022; 21 (03) 487-499
13 Crippen MM, Patel N, Filimonov A. et al. Association of smoking tobacco with complications in head and neck microvascular reconstructive surgery. JAMA Facial Plast Surg 2019; 21 (01) 20-26
14 Garip M, Van Dessel J, Grosjean L, Politis C, Bila M. The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 59 (03) e79-e98
15 Makwana M, Taylor PN, Stew BT, Shone G, Hayhurst C. Smoking and obesity are risk factors for thirty-day readmissions following skull base surgery. J Neurol Surg B Skull Base 2020; 81 (02) 206-212
16 Kidwai SM, Yang A, Gray ML. et al. Hospital charge variability across New York State: sociodemographic factors in pituitary surgery. J Neurol Surg B Skull Base 2019; 80 (06) 612-619
17 Shahrestani S, Ballatori AM, Chen XT. et al. Analysis of modifiable and nonmodifiable risk factors in patients undergoing pituitary surgery. J Neurosurg 2020; 134 (06) 1816-1823
18 Lassig AAD, Bechtold JE, Lindgren BR. et al. Tobacco exposure and wound healing in head and neck surgical wounds. Laryngoscope 2018; 128 (03) 618-625
19 Hatcher JL, Sterba KR, Tooze JA. et al. Tobacco use and surgical outcomes in patients with head and neck cancer. Head Neck 2016; 38 (05) 700-706
20 Wiedmann M, Brunborg C, Lindemann K. et al. Smoking, obesity and the risk of pituitary adenoma: a large prospective cohort study (The HUNT Study). Eur J Epidemiol 2016; 31 (01) 95-98
21 Benson VS, Green J, Pirie K, Beral V. Cigarette smoking and risk of acoustic neuromas and pituitary tumours in the Million Women Study. Br J Cancer 2010; 102 (11) 1654-1656
22 McDaniel JC, Browning KK. Smoking, chronic wound healing, and implications for evidence-based practice. J Wound Ostomy Continence Nurs 2014; 41 (05) 415-423 , quiz E1–E2
23 Kean J. The effects of smoking on the wound healing process. J Wound Care 2010; 19 (01) 5-8
24 Fan Chiang YH, Lee YW, Lam F, Liao CC, Chang CC, Lin CS. Smoking increases the risk of postoperative wound complications: a propensity score-matched cohort study. Int Wound J 2023; 20 (02) 391-402
25 Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 2003; 238 (01) 1-5
26 Manassa EH, Hertl CH, Olbrisch RR. Wound healing problems in smokers and nonsmokers after 132 abdominoplasties. Plast Reconstr Surg 2003; 111 (06) 2082-2087 , discussion 2088–2089
27 Sørensen LT, Hørby J, Friis E, Pilsgaard B, Jørgensen T. Smoking as a risk factor for wound healing and infection in breast cancer surgery. Eur J Surg Oncol 2002; 28 (08) 815-820
28 Ahn C, Mulligan P, Salcido RS. Smoking-the bane of wound healing: biomedical interventions and social influences. Adv Skin Wound Care 2008; 21 (05) 227-236 , quiz 237–238
29 Gâta A, Toader C, Trombitaș VE, Ilyes A, Albu S. Endoscopic skull base repair strategy for CSF leaks associated with pneumocephalus. J Clin Med 2020; 10 (01) E46
30 Khan DZ, Ali AMS, Koh CH. et al. Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review. Pituitary 2021; 24 (05) 698-713
31 Jolly K, Gupta KK, Bhamra N, Aslanidou A, Batra R, Ahmed SK. Endonasal endoscopic management of spontaneous cerebrospinal fluid rhinorrhoea: the Birmingham UK experience. Asian J Endosc Surg 2023; 16 (01) 68-76
32 Chaskes MB, Barton B, Karsy M. et al. An algorithm for sellar reconstruction following endoscopic transsphenoidal surgery for pituitary adenoma: a review of 582 cases. Int Forum Allergy Rhinol 2022; 12 (09) 1120-1130
33 Conger A, Zhao F, Wang X. et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients. J Neurosurg 2018; 130 (03) 861-875
34 Hadad G, Bassagasteguy L, Carrau RL. et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
35 Fields D, McDowell M, Schulien A. et al. Low preoperative prealbumin levels are a strong independent predictor of postoperative cerebrospinal fluid leak following endoscopic endonasal skull base surgery. World Neurosurg 2022; 167: e110-e116
36 Hawn MT, Houston TK, Campagna EJ. et al. The attributable risk of smoking on surgical complications. Ann Surg 2011; 254 (06) 914-920
37 Carmel Neiderman NN, Wengier A, Dominsky O. et al. A prospective evaluation of quality of life in patients undergoing extended endoscopic endonasal surgery for benign pituitary gland lesion. J Neurol Surg B Skull Base 2021; 83 (Suppl. 02) e386-e394
38 Phillips KM, Hoehle L, Bergmark RW, Caradonna DS, Gray ST, Sedaghat AR. Reversal of smoking effects on chronic rhinosinusitis after smoking cessation. Otolaryngol Head Neck Surg 2017; 157 (04) 737-742