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

Author

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, and Ahmad R. Sedaghat

Subjects
Neurology (clinical)
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.

Published
2023
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6. Contributors

Author

Isaac J. Abecassis, Todd A. Abruzzo, Joseph G. Adel, Amin Aghaebrahim, Pedro Aguilar-Salinas, Marjan Alimi, Zaid S. Aljuboori, Norberto O. Andaluz, Adam S. Arthur, Robin Babadjouni, H. Hunt Batjer, Ankur Bhambri, Mandy J. Binning, Alan S. Boulos, Leonardo B.C. Brasiliense, Waleed Brinjikji, Christopher P. Carroll, Ahmed Cheema, Stephen R. Chen, Jacob Cherian, Vincent Cheung, Nathan L. Colon, John C. Dalfino, Rafael de Oliveira Sillero, David S. Dieppa, Sabih T. Effendi, Adam Elwood, Kyle M. Fargen, Vernard S. Fennell, Richard D. Fessler, Enzo S. Fortuny, Laura Galarza-Paez, M. Reid Gooch, Sricharan Gopakumar, Nitin Goyal, Karen Greenberg, Christoph J. Griessenauer, Vivek Gupta, Ricardo A. Hanel, Carman Wayne Hamm, Hirad S. Hedayat, Daniel Hoit, Jay U. Howington, Robert F. James, Rashid M. Janjua, Lincoln Jimenez, Peter Kan, Alexander Khalessi, Usman A. Khan, Nicolas K. Khattar, Louis J. Kim, David J. Langer, Giuseppe Lanzino, Michael R. Levitt, Elad I. Levy, Kenneth Liebman, Yahia M. Lodi, William J. Mack, Justin Mascitelli, Nikhil Mehta, Kenneth A. Moore, Juan C. Mejia Munne, Christopher Nickele, Jeffrey C. Obiora, Thomas Adam Oliver, Atilio Palma, Aditya S. Pandey, Jeffrey S. Pannell, Maunik Patel, Glenn Pollock, Syed A. Rahman, Ralph Rahme, Robert C. Rennert, Andrew J. Ringer, Roberta Santos, Eric Sauvageau, Luis E. Savastano, Clemens M. Schirmer, Joseph C. Serrone, Adnan H. Siddiqui, Jasmeet Singh, Alejandro M. Spiotta, Visish M. Srinivasan, Robert Starke, Jeffrey A. Steinberg, Douglas L. Stofko, Tejaswi D. Sudhakar, Ryan D. Tackla, Justin G. Thomas, Raymond D. Turner, Jan Vargas, Erol Veznedaroglu, Prasanna Vibhute, Shawn M. Vuong, Brian P. Walcott, Arvin R. Wali, Babu G. Welch, Andrew C. White, Jonathan A. White, Timothy G. White, Robert T. Wicks, David Andrew Wilkinson, John A. Wilson, Stacey Q. Wolfe, Junichi Yamamoto, Benjamin Yim, and Christopher C. Young

Published
2018
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