PERIOPERATIVE COMPLICATIONS ASSOCIATED WITH ROUTINE PREOPERATIVE GLUCOCORTICOID USE AMONG PITUITARY SURGERY PATIENTS WITH NORMAL PREOPERATIVE HPA AXIS

A RETROSPECTIVE COHORT STUDY

Abstract

INTRODUCTION
This study determined the incidence of perioperative complications associated with routine preoperative glucocorticoid use in pituitary surgery patients with normal preoperative hypothalamo-pituitary-adrenal axis (HPA axis).

METHODOLOGY
In a retrospective chart review from 2011-2021, 243 patients with normal preoperative HPA axis who underwent pituitary surgery were divided into 2 groups: 1) with preoperative steroids and 2) without preoperative steroids, and evaluated for subsequent development of postoperative complications.

RESULTS
The incidence of composite postoperative complications of in-hospital mortality, postoperative infection, and postoperative diabetes insipidus was significantly increased among those with preoperative steroids compared to those without (58.33% versus 33.33%, p = 0.004), with an adjusted odds ratio of 2.90 (CI: 1.29 to 6.53, p = 0.010). Among the components of the composite outcome, post-operative diabetes insipidus was statistically higher among those given preoperative steroids (52.45% vs 28.21%, p = 0.006) with an adjusted OR of 3.31 (CI: 1.43 to 7.67, p = 0.005). The incidence of postoperative adrenal insufficiency was similar between the groups (20.15% with steroids vs 8.70% without steroids, p = 0.258).

CONCLUSION
Among patients with normal preoperative HPA axis who underwent pituitary surgery, routine preoperative steroid use was associated with an increased risk of composite postoperative complications (in-hospital mortality, postoperative infection, postoperative diabetes insipidus).