Effect of preoperative anemia on surgical outcomes in endonasal transsphenoidal surgery for pituitary adenoma: a matched-cohort study.

PURPOSE: Neuroendocrine dysfunction and surgical complications are concerns of endonasal transsphenoidal surgery (ETA). Preoperative anemia has been linked to increased morbidity in various surgical procedures; however, its effect on the outcomes of pituitary surgery remains unclear. We aimed to evaluate the associations among preoperative anemia, postoperative complications, and neuroendocrine dysfunction in patients undergoing ETA for pituitary adenoma (PA).

METHODS

For this retrospective population-based study, we used the TriNetX global research network to identify adult patients with PA who underwent ETA (2005-2023). The patients were classified into anemic and non-anemic (control) cohorts based on their preoperative hemoglobin and hematocrit levels. Propensity score matching (PSM) was used to balance baseline characteristics. Postoperative surgical and neuroendocrine outcomes were compared using odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis was performed based on anemia severity. The primary outcomes included perioperative complications and postoperative endocrine function.

RESULTS

After PSM, 2,242 patients were included in each group. The anemic group had higher odds of postoperative meningitis (3.4% vs. 1.7%, OR: 2.01, p < 0.001), lumbar drain placement (7.0% vs. 2.7%, OR: 2.68, p < 0.001), and early reoperation (5.0% vs. 2.9%, OR: 1.76, p < 0.001). Neuroendocrine complications, including diabetes insipidus (25.3% vs. 21.6%, OR: 1.23, p = 0.004), syndrome of inappropriate antidiuretic hormone secretion/hyponatremia (13.5% vs. 6.3%, OR: 2.35, p < 0.001), hypopituitarism (68.6% vs. 59.8%, OR: 1.47, p < 0.001), and an increased need for hormone replacement therapy, were also more frequent in the anemic group. While patients with moderate-to-severe anemia had higher risks of postoperative endocrine dysfunction and visual disturbances, the severity of anemia did not significantly affect the odds of perioperative complications.

CONCLUSIONS

Preoperative anemia was associated with increased risks of both surgical and neuroendocrine complications post-ETA for PA. Our findings highlight the importance of identifying and managing anemia preoperatively to optimize outcomes and reduce postoperative morbidity.