Causes and risk factors of recent death for sellar tumors after endoscopic transsphenoidal surgery: analysis of 1 635 cases

Abstract

Objective To investigate the causes and risk factors of recent death (within 30 d postoperatively) of patients with sellar tumors after endoscopic transsphenoidal surgery (ETS). Methods The clinical data of the patients with sellar tumors after ETS in our department from January 2011 to March 2021 were collected and retrospectively analyzed. Death cases were collected. Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors for postoperative death. Results In the past 10 years, there were 1 635 cases of ETS surgery in our department, including 1 470 cases of endoscopic transsphenoidal approach (ETA), and 165 cases of extend endoscopic transsphenoidal approach (EETA). Nine patients died recently after operation, with a mortality of 0.55% (9/1 635). The causes of death included: ① hemorrhage in the operative area in 3 cases (subarachnoid hemorrhage in 1 case and residual tumor hemorrhage in the operative area in 2 cases); ② infection in 3 cases (2 cases of meningitis and 1 case of blood-borne infection); ③ hypothalamus injury in 1 case; ④ vascular injury in 1 case; ⑤ epileptic status in 1 case. Univariate analysis showed that diameter >3 cm, tough consistency, large amount of intraoperative blood loss, intraoperative cerebrospinal fluid (CSF) leakage, persistent postoperative CSF leakage, remnant tumor, and treatment of EETA may be associated with postoperative death after ETS (all P < 0.05). Multivariate logistic regression analysis indicated that intraoperative CSF leakage was the only independent risk factor. Conclusion The main causes of recent death of insellar tumor patients after ETS are hemorrhage in surgical area, meningitis and blood-borne infection. Those with intraoperative CSF leakage are more likely to die.

Keywords

• sellar tumor
• endoscopic transsphenoidal surgery
• causes of death
• risk factors