Table_1_Impact of metabolic syndrome on postoperative outcomes of transsphenoidal pituitary surgery: analysis of U.S. nationwide inpatient sample data 2005–2018.docx

IntroductionTranssphenoidal surgery (TSS) is the preferred surgical method for most pituitary adenomas owing to high efficacy and low mortality. This study aimed to evaluate the influence of metabolic syndrome (MetS) on postoperative outcomes of TSS for pituitary adenoma.
MethodsThis population-based, retrospective observational study extracted data of adults 20-79 y receiving TSS for pituitary adenoma from the US Nationwide Inpatient Sample (NIS) between 2005-2018. Primary outcomes were pituitary-related complications, poor outcomes (i.e., in-hospital mortality or unfavorable discharge), prolonged length of stay (LOS), and patient safety indicators (PSIs). Univariate and multivariate regressions were performed to determine the associations between study variables and outcomes.
Results19,076 patients (representing a 93,185 US in-patient population) were included, among which 2,109 (11.1%) patients had MetS. After adjustment, pre-existing MetS was not significantly associated with presence of pituitary-related complications and poor outcomes. In contrast, MetS was significantly associated with an increased risk for prolonged LOS (adjusted OR (aOR) = 1.19; 95% CI: 1.05-1.34), PSIs (aOR = 1.31; 95% CI: 1.07-1.59) and greater hospital costs (adjusted β = 8.63 thousand USD; 95% CI: 4.98-12.29). Among pituitary-related complications, MetS was independently associated with increased risk of cerebrospinal fluid (CSF) rhinorrhea (aOR = 1.22, 95% CI: 1.01, 1.47) but lowered diabetes insipidus (aOR = 0.83, 95% CI: 0.71, 0.97).
DiscussionMetS does not pose excessive risk of in-hospital mortality or unfavorable discharge. However, MetS independently predicted having PSIs, prolonged LOS, greater hospital costs, and CSF rhinorrhea. Study findings may help clinicians achieve better risk stratification before TSS.

经蝶窦手术（Transsphenoidal surgery, TSS）因疗效确切、死亡率低，是多数垂体腺瘤的首选手术方案。本研究旨在评估代谢综合征（Metabolic syndrome, MetS）对垂体腺瘤患者行经蝶窦手术后临床转归的影响。
方法 本项基于人群的回顾性观察研究，从2005年至2018年美国全国住院患者样本（Nationwide Inpatient Sample, NIS）数据库中，提取20至79岁因垂体腺瘤接受经蝶窦手术的成年患者数据。本研究的主要结局指标包括垂体相关并发症、不良转归（即院内死亡或出院转归不佳）、住院时间延长（Length of stay, LOS）以及患者安全指标（Patient Safety Indicators, PSIs）。采用单因素及多因素回归分析，明确研究变量与各结局指标间的关联。
结果 本研究共纳入19076例患者（对应美国93185例住院患者人群），其中2109例（11.1%）合并代谢综合征。经校正后，术前合并代谢综合征与垂体相关并发症、不良转归均无显著相关性。与之相反，代谢综合征与住院时间延长（校正后比值比[adjusted OR, aOR]=1.19；95%置信区间[CI]：1.05~1.34）、患者安全指标升高（aOR=1.31；95%CI：1.07~1.59）以及更高的住院费用（校正后β=8.63千美元；95%CI：4.98~12.29）风险显著相关。在垂体相关并发症中，代谢综合征与脑脊液（Cerebrospinal fluid, CSF）鼻漏风险升高独立相关（aOR=1.22，95%CI：1.01~1.47），但与尿崩症风险降低相关（aOR=0.83，95%CI：0.71~0.97）。
讨论 代谢综合征并未显著增加院内死亡或出院转归不佳的风险。然而，代谢综合征可独立预测患者安全指标升高、住院时间延长、住院费用增加以及脑脊液鼻漏的发生。本研究结果有助于临床医师在经蝶窦手术前更好地开展风险分层管理。