Predictors of Sinonasal Quality of Life following Endoscopic Endonasal Transsphenoidal Pituitary Surgery in a Multicenter Prospective Trial

Introduction: Sinonasal morbidity following endoscopic endonasal approaches for pituitary tumors is an important determinant of patient recovery after surgery. Efforts to assess sinonasal quality of life (QOL) have been limited by largely retrospective, single-surgeon, single-center studies without predefined follow-up intervals. The purpose of this multicenter, prospective outcomes study was to identify early and late predictors of sinonasal QOL following endoscopic endonasal pituitary surgery (EEPS) and to evaluate return to baseline sinonasal QOL.

Methods: Adult patients with pituitary lesions undergoing standard endoscopic transsphenoidal surgery were eligible. Patient-reported sinonasal QOL was assessed at baseline, 2 weeks (early) and through 12 weeks (late) after pituitary surgery using the Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12), a site-specific QOL instrument developed and validated in endoscopic endonasal pituitary. Adult patients were enrolled in a multicenter QOL study (NCT03014687). Univariate and multivariable analyses were conducted to identify predictors of QOL after surgery. Exploratory covariates included demographics, tumor characteristics, medical history, social history, and surgical techniques.

Results: 113 adult patients treated at 3 centers by 4 neurosurgeons and 9 otolaryngologists were included ([Fig. 1]). In a univariate analysis, predictors of improved early sinonasal QOL included no sinusitis (13.35 ± 8.48 vs. 24.5 ± 13.6, p = 0.015) and baseline QOL score (r (108) = 0.199, p = 0.04, Pearson's correlation). Predictors of improved late QOL included no history of headaches (4.8 ± 6.2 vs 7.8 ± 8.53, p = 0.04) and not undergoing a nasal debridement (3.23 ± 4.46 vs. 6.68 ± 7.68, p = 0.02). Multivariable analysis using ANOVA and logistic regression identified no predictors of QOL at either time point. At 2 weeks postoperatively, sinonasal QOL in 43/113 (38.1%) patients had either returned to baseline or improved. By 12 weeks, sinonasal QOL in 80/113 (70.8%) patients had either retuned to baseline or improved.

Conclusion: In this multicenter, prospective QOL study, we identified no specific predictors of sinonasal QOL at 12 weeks in a multivariable analysis, suggesting that the nasal cavity has robust capacity to heal in a variety of clinical contexts. Most patients report a return to or improvement beyond baseline QOL at 12 weeks after surgery.

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Artikel online veröffentlicht:
12. Februar 2021