Impact of preoperative smoking on outcomes of endoscopic transsphenoidal surgery for pituitary tumor.

OBJECTIVE

Cigarette smoking and nicotine dependence are prevalent in the general population and can negatively impact surgical outcomes. However, the effect of preoperative smoking status on the outcomes of endonasal transsphenoidal surgery (ETS) for pituitary adenomas (PA) remains unknown. This study aims to investigate the impact of preoperative smoking status on the outcomes following endonasal transsphenoidal surgery.

METHODS

A retrospective, international, multi-center, propensity score matched (PSM), cohort study was conducted using the TriNetX database. Adult patients diagnosed with PA who underwent endoscopic transsphenoidal excision between 2005 and 2024 were identified. Patients with documented cigarette smoking or nicotine dependence within six months prior to ETS were classified as the smoker cohort, while those without either were classified as the non-smoker (control) cohort. Propensity score matching was performed based on key covariates, including age, sex, race, comorbidities, and preoperative neuroendocrine function.

RESULTS

The crude cohort included a total of 11,472 patients. After PSM, 1623 patients were included in both the smoker and non-smoker groups. The mean age at ETS was 50.9 years. Compared to the non-smoker group, smoker patients were associated with a higher incidence of postoperative cerebrospinal fluid (CSF) leakage (OR:1.31; 95%CI:1.05-1.62; p = 0.027), meningitis (OR:1.59; 95%CI:1.02-2.50; p = 0.047), postoperative diabetes insipidus (DI) (OR:1.22; 95%CI:1.04-1.43; p = 0.018), desmopressin use (OR:1.29; 95%CI:1.07-1.56; p = 0.009), hypopituitarism (OR:1.06; 95%CI:1.01-1.33; p = 0.048), and steroid use (OR:1.19; 95%CI:1.01-1.40; p = 0.035). Sensitivity analysis demonstrated consistent results across the different PSM models.

CONCLUSIONS

Among patients undergoing ETS for PA, preoperative smoking status was associated with higher risks of postoperative CSF leakage, meningitis, DI, desmopressin use, hypopituitarism, and steroid use.