Impact of preoperative sinusitis on surgical outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery: a real-world population-based cohort study

OBJECTIVE: The endonasal endoscopic transsphenoidal approach (ETA) is the standard approach for pituitary adenomas (PAs). Chronic sinusitis is a prevalent condition affecting 2%-15% of the general population. However, the impact of preoperative sinusitis on the outcomes of ETA for PA remains unknown. This study investigated the impact of preoperative sinusitis on the outcomes of ETA for PA. METHODS: A retrospective cohort analysis was conducted using the TriNetX database. Propensity score matching (PSM) was performed to form two balanced groups to compare patients with and without preoperative chronic sinusitis who underwent subsequent ETA for PAs. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the TriNetX platform to compare the perioperative and neuroendocrine outcomes. RESULTS: The crude cohort included a total of 10,675 patients. After PSM, 842 patients were included in both the sinusitis and nonsinusitis groups. The mean age at ETA was 54.3 and 55.0 years in the sinusitis and nonsinusitis groups, respectively. Compared to the nonsinusitis group, patients in the sinusitis group had a higher incidence of postoperative CSF leakage (OR 1.47, 95% CI 1.06-2.03; p = 0.021), meningitis (OR 2.47, 95% CI 1.25-4.87; p = 0.007), postoperative diabetes insipidus (DI) (OR 1.47, 95% CI 1.17-1.83; p = 0.001), desmopressin use (OR 1.77, 95% CI 1.34-2.33; p = 0.001), and steroid use (OR 1.46, 95% CI 1.15-1.85; p = 0.002). Sensitivity analysis demonstrated consistent results across the different matching models. CONCLUSIONS: In patients who underwent ETA for PAs, preoperative sinusitis was associated with an increased risk of postoperative CSF leakage, meningitis, DI, desmopressin use, and steroid use.