Association between preoperative medication lists and postoperative hospital length of stay after endoscopic transsphenoidal pituitary surgery

Background: Endoscopic transsphenoidal surgery is the most common
technique for resection of pituitary adenoma. Data on factors associated
with extended hospital stay after this surgery are limited. We aimed to
characterize the relationship between preoperative medications and the
risk of prolonged postoperative length of stay after this procedure.
Methods: This single-center, retrospective cohort study included all adult
patients scheduled for transsphenoidal pituitary surgery from July 1st,
2016 to December 31st, 2019. Anatomical Therapeutic Chemical codes were
used to identify patients’ preoperative medications. The primary outcome
was prolonged postoperative hospital length of stay. Secondary outcomes
included unplanned admission to the Intensive Care Unit, in-hospital and
one-year mortality. We developed a descriptive logistic model that
included preoperative medications, obesity, and age. Results: Median
postoperative length of stay was 3 days for the 704 analyzed patients. A
prolonged length of stay was defined as > 4 days. Patients taking
ATC-H drugs were at increased risk of prolonged length of stay (OR 1.56,
95% CI 1.26-1.95, p<0.001). No association was found between
preoperative ATC-H medication and unplanned ICU admission or in-hospital
mortality. Patients with multiple preoperative ATC-H medications had
significantly higher mean LOS (5.4 ± 7.6 days) and one-year mortality
(p<0.02). Conclusions: Clinicians should be aware of the possible
vulnerability of patients taking systemic hormones preoperatively. Future
studies should test this medication-based approach on endoscopic
transsphenoidal pituitary surgery populations from different hospitals and
countries.