Effects of psychological and physiological factors in perioperative thirst discomfort trajectories in endonasal transsphenoidal surgery: a prospective cohort study

Background: Endonasal transsphenoidal surgery (ETSS) is a minimally invasive treatment for pituitary adenomas. Perioperative thirst discomfort is common and may signal complications like diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion. Understanding the psychological and physiological factors influencing thirst is crucial for improving patient care. Materials and methods: This prospective cohort study enrolled 224 ETSS patients from July 2024 to December 2024 at a tertiary hospital in China. We measured thirst discomfort, the salivary pH, and serum thyroid thyroid-stimulating hormone (TSH) levels at multiple perioperative time points and collected data on demographics, anxiety, and depression. Latent growth mixture modeling identified thirst trajectories, principal component analysis determined key TSH and pH patterns, logistic regression assessed influencing factors, and structural equation modeling explored pathways among psychological and physiological variables. Results: Four distinct thirst discomfort trajectories were identified: low-level rapid relief, high-level unresolved, low-level slow relief, and low-level continuous deterioration. Principal component analysis revealed a stable decreasing trend in TSH, while salivary pH followed three trends, including stable decrease, postoperative recovery, and early fluctuations. Protective factors for the high-level unresolved group included stable decreasing TSH trends and higher anxiety, while diabetes and depression were risk factors. For the low-level slow relief group, stable decreasing TSH trends and higher anxiety were protective. The low-level continuous deterioration group was influenced by a decreasing pH trend as a risk factor, with stable decreasing TSH trends providing protection. Path analysis indicated that stable decreasing TSH trends were negatively correlated with anxiety and influenced pH stability, impacting thirst discomfort. Conclusion: Perioperative thirst discomfort in ETSS patients exhibits significant heterogeneity influenced by both psychological and physiological parameters (TSH levels and salivary pH). Identifying these factors can inform targeted perioperative management strategies, potentially mitigating thirst-related discomfort and improving overall patient outcomes.