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J Neurol Surg B Skull Base
DOI: 10.1055/a-2505-7941
Original Article

Race and Cerebrospinal Fluid Leaks: Concerning Associations after Endonasal Transsphenoidal Pituitary Resection

Ross Rosen 
1   Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
,
Claudia I. Cabrera
1   Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
2   Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates
,
Daniel Karasik
1   Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
,
John Richter
1   Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
,
Kenneth Rodriguez
1   Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
2   Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates
,
Sanjeet V. Rangarajan
1   Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
2   Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates
,
Brian D'Anza
1   Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
2   Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates
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Abstract

Objective To identify and describe differences in the rates of cerebrospinal fluid (CSF) leaks after transsphenoidal pituitary resection (TSPR) on a demographic basis.

Design Multi-institution health care database study.

Setting TriNetX research database.

Methods The database TriNetX was searched for rates of CSF leaks after TSPR. Patients were excluded if they had a CSF leak diagnosed any time prior to postoperative day number one. Demographic factors such as sex and race were compared in cohorts matched by other demographic characteristics, obstructive sleep apnea, body mass index categories, functional adenoma status, nicotine use, and concurrent lumbar drain placement.

Results A total of 8,741 patients were included in the analysis, with a total rate of postoperative CSF leak of 2.62%. After matching, race and sex were both significant risk factors for CSF leak, with Black patients having a higher risk when compared with White patients (risk ratio [RR]: 1.68, 95% confidence interval [CI]: 1.08–2.60) and females having a higher risk compared with males (RR: 1.33, 95% CI: 1.00–1.77).

Conclusion Even when matching for obstructive sleep apnea, weight, functional adenoma status, nicotine use, and concurrent lumbar drain placement, Black and female patients had higher rates of CSF leaks in the month following surgery. This finding highlights an important gap in the literature that should be addressed through future prospective studies and the need to better understand potential demographic disparities in health care.

Keywords

disparities - health inequity - pituitary adenoma - transsphenoidal - skull base surgery - postoperative outcomes - diversity - equity and inclusion

Data Availability Statement

All data supporting the findings of this study are available within the paper and its Supplementary Information.




Publication History

Received: 10 October 2024

Accepted: 16 December 2024

Accepted Manuscript online:
19 December 2024

Article published online:
23 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Grotenhuis JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol 2005; 64 (06) 490-493 , discussion 493–494
    CrossrefPubMedSearch in Google Scholar
  • 2 van Aken MO, Feelders RA, de Marie S. et al. Cerebrospinal fluid leakage during transsphenoidal surgery: postoperative external lumbar drainage reduces the risk for meningitis. Pituitary 2004; 7 (02) 89-93
    CrossrefPubMedSearch in Google Scholar
  • 3 Slot EMH, Sabaoglu R, Voormolen EHJ, Hoving EW, van Doormaal TPC. Cerebrospinal fluid leak after transsphenoidal surgery: a systematic review and meta-analysis. J Neurol Surg B Skull Base 2021; 83 (Suppl. 02) e501-e513
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Han ZL, He DS, Mao ZG, Wang HJ. Cerebrospinal fluid rhinorrhea following trans-sphenoidal pituitary macroadenoma surgery: experience from 592 patients. Clin Neurol Neurosurg 2008; 110 (06) 570-579
    CrossrefPubMedSearch in Google Scholar
  • 5 Patel PN, Stafford AM, Patrinely JR. et al. Risk factors for intraoperative and postoperative cerebrospinal fluid leaks in endoscopic transsphenoidal sellar surgery. Otolaryngol Head Neck Surg 2018; 158 (05) 952-960
    CrossrefPubMedSearch in Google Scholar
  • 6 Huyett P, Soose RJ, Schell AE. et al. Risk of postoperative complications in patients with obstructive sleep apnea following skull base surgery. Otolaryngol Head Neck Surg 2018; 158 (06) 1140-1147
    CrossrefPubMedSearch in Google Scholar
  • 7 Zimmermann TM, Marcellino CR, Choby GW. et al. Timing of postoperative CSF leak after endoscopic skull base surgery in patients with obstructive sleep apnea. J Neurol Surg B Skull Base 2019; 80 (04) 392-398
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Zhao J, Wang S, Zhao X, Cui H, Zou C. Risk factors of cerebrospinal fluid leakage after neuroendoscopic transsphenoidal pituitary adenoma resection: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 14: 1263308
    CrossrefPubMedSearch in Google Scholar
  • 9 Stanford FC. The importance of diversity and inclusion in the healthcare workforce. J Natl Med Assoc 2020; 112 (03) 247-249
    PubMedSearch in Google Scholar
  • 10 Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 1999; 341 (18) 1359-1367
    CrossrefPubMedSearch in Google Scholar
  • 11 Chetty R, Stepner M, Abraham S. et al. The association between income and life expectancy in the United States, 2001-2014. JAMA 2016; 315 (16) 1750-1766
    CrossrefPubMedSearch in Google Scholar
  • 12 Cote DJ, Ostrom QT, Gittleman H. et al. Glioma incidence and survival variations by county-level socioeconomic measures. Cancer 2019; 125 (19) 3390-3400
    CrossrefPubMedSearch in Google Scholar
  • 13 Curry Jr WT, Barker II FG. Racial, ethnic and socioeconomic disparities in the treatment of brain tumors. J Neurooncol 2009; 93 (01) 25-39
    CrossrefPubMedSearch in Google Scholar
  • 14 Mackenbach JP, Stirbu I, Roskam AJ. et al; European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008; 358 (23) 2468-2481
    CrossrefPubMedSearch in Google Scholar
  • 15 Wiemken TL, Carrico RM, Furmanek SP. et al. Socioeconomic position and the incidence, severity, and clinical outcomes of hospitalized patients with community-acquired pneumonia. Public Health Rep 2020; 135 (03) 364-371
    CrossrefPubMedSearch in Google Scholar
  • 16 Sabahi M, Maroufi SF, Wierzbicka A, Maniakhina L, Adada B, Borghei-Razavi H. Healthcare disparities in pituitary surgery: a systematic review. Neurosurg Focus 2023; 55 (05) E15
    CrossrefPubMedSearch in Google Scholar
  • 17 Gordon AJ, Dastagirzada Y, Schlacter J. et al. Health care disparities in transsphenoidal surgery for pituitary tumors: an experience from neighboring urban public and private hospitals. J Neurol Surg B Skull Base 2022; 84 (06) 560-566
    PubMedSearch in Google Scholar
  • 18 Tiwari C, Maung E, Gelinne A. et al. Disparities in postoperative endocrine outcomes after endoscopic-assisted transsphenoidal pituitary adenoma resection. Cureus 2022; 14 (11) e31934
    PubMedSearch in Google Scholar
  • 19 Totten DJ, Schueth E, Saltagi MZ. et al. Trends in spontaneous cerebrospinal fluid leak repairs in the United States, 2009-2018. Otol Neurotol Open 2022; 2 (04) e021
    CrossrefPubMedSearch in Google Scholar
  • 20 Alshakhs M, Jackson B, Ikponmwosa D, Reynolds R, Madlock-Brown C. Multimorbidity patterns across race/ethnicity as stratified by age and obesity. Sci Rep 2022; 12 (01) 9716
    CrossrefPubMedSearch in Google Scholar
  • 21 Lobo BC, Baumanis MM, Nelson RF. Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review. Laryngoscope Investig Otolaryngol 2017; 2 (05) 215-224
    CrossrefPubMedSearch in Google Scholar
  • 22 Wang MTM, Bhatti MT, Danesh-Meyer HV. Idiopathic intracranial hypertension: pathophysiology, diagnosis and management. J Clin Neurosci 2022; 95: 172-179
    CrossrefPubMedSearch in Google Scholar
  • 23 Kuan V, Denaxas S, Patalay P. et al; Multimorbidity Mechanism and Therapeutic Research Collaborative (MMTRC). Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health 2023; 5 (01) e16-e27
    CrossrefPubMedSearch in Google Scholar
  • 24 Tampourlou M, Fountas A, Ntali G, Karavitaki N. Mortality in patients with non-functioning pituitary adenoma. Pituitary 2018; 21 (02) 203-207
    CrossrefPubMedSearch in Google Scholar
  • 25 Cote DJ, Ruzevick JJ, Kang KM. et al. Association between socioeconomic status and presenting characteristics and extent of disease in patients with surgically resected nonfunctioning pituitary adenoma. J Neurosurg 2022; 137 (06) 1699-1706
    CrossrefPubMedSearch in Google Scholar
  • 26 Birkenbeuel JL, Lehrich BM, Goshtasbi K, Abiri A, Hsu FPK, Kuan EC. Refusal of surgery in pituitary adenoma patients: a population-based analysis. Cancers (Basel) 2022; 14 (21) 20221030
    CrossrefPubMedSearch in Google Scholar
  • 27 Butterfield JT, Golzarian S, Johnson R. et al. Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis. Lancet 2022; 400 (10368): 2063-2073
    CrossrefPubMedSearch in Google Scholar
  • 28 Chalif EJ, Couldwell WT, Aghi MK. Effect of facility volume on giant pituitary adenoma neurosurgical outcomes. J Neurosurg 2022; 137 (03) 658-667
    CrossrefPubMedSearch in Google Scholar
  • 29 Mukherjee D, Zaidi HA, Kosztowski T. et al. Predictors of access to pituitary tumor resection in the United States, 1988-2005. Eur J Endocrinol 2009; 161 (02) 259-265
    CrossrefPubMedSearch in Google Scholar
  • 30 Stone G, Samaan JS, Samakar K. Racial disparities in complications and mortality after bariatric surgery: a systematic review. Am J Surg 2022; 223 (05) 863-878
    CrossrefPubMedSearch in Google Scholar
  • 31 Abella MKIL, Lee AY, Agonias K, Maka P, Ahn HJ, Woo RK. Racial disparities in general surgery outcomes. J Surg Res 2023; 288: 261-268
    CrossrefPubMedSearch in Google Scholar
  • 32 Singh P, Debbaneh P, Rivero A. Racial disparities in tympanoplasty surgery: a 30-day morbidity and mortality national cohort study. Otol Neurotol 2022; 43 (10) e1129-e1135
    CrossrefPubMedSearch in Google Scholar
  • 33 Iwata AJ, Williams AM, Taylor AR, Chang SS. Socioeconomic disparities and comorbidities, not race, affect salivary gland malignancy survival outcomes. Laryngoscope 2017; 127 (11) 2545-2550
    CrossrefPubMedSearch in Google Scholar
  • 34 Alharbi S, Harsh G, Ajlan A. Perioperative lumbar drain utilization in transsphenoidal pituitary resection. Neurosciences (Riyadh) 2018; 23 (01) 46-51
    CrossrefPubMedSearch in Google Scholar
  • 35 Zwagerman NT, Wang EW, Shin SS. et al. Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg 2018; 131 (04) 1172-1178
    CrossrefPubMedSearch in Google Scholar
  • 36 Honegger J, Grimm F. The experience with transsphenoidal surgery and its importance to outcomes. Pituitary 2018; 21 (05) 545-555
    CrossrefPubMedSearch in Google Scholar