Abstract
Object:
Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing endoscopic transsphenoidal surgery.
Methods:
An exploratory post-hoc analysis was conducted of patients undergoing endoscopic pituitary surgery enrolled in a prospective multicenter QOL study. Endpoints of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery.
Results:
Data from 100 patients who underwent endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were used of nasal splints (
p
= 0.039) and female gender at the trend level (
p
= 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (
p
= 0.025), age (
p
= 0.044), and use of absorbable nasal packing (
p
= 0.014). Health status was also predictive at 2 weeks (
p
= 0.001) and 3 months (
p
< 0.001), and was the only significant predictor of sinonasal QOL at 6 months (
p
< 0.001). Mean time ( ± SD) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopuruence.
Conclusion:
The predictors of sinonasal morbidity change during the healing process. Certain surgical techniques, such as use of absorbable packing and nasal splints, negatively correlate with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.