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A Nationwide Inpatient Database Assessment of Pituitary Tumor Resection Complications

Asokan D, Pisklakov S
UMDNJ - New Jersey Medical School, Newark, New jersey, United states

Introduction

The Nationwide Inpatient Sample (NIS) contains all-payer data on hospital inpatient stays from states participating in the Healthcare Cost and Utilization Project (HCUP)(5). It explores a range and incidence of perioperative complications associated with pituitary tumor resection.

Materials and Methods

Hospitalizations for pituitary tumor resections were identified by cross-matching International Classification of Diseases-9 codes for diagnoses of pituitary tumor and perioperative complications of interest for pituitary tumor resection. The database was selected for patients with pituitary tumor diagnoses ICD-9-CM 194.3, 198.89, 234.8, 227.3, 237.0. Of these diagnoses pituitary tumor resections were selected with codes ICD-9-CM 07.61-07.65, 07.68, 07.69, 07.71.

6019 cases of pituitary tumor resections were analyzed for anesthetic [utilizing ICD-9-CM codes 995.89, 995.86, 995.4, E876.3, E938.1, E938.2, E938.4, E938.7, 968.1-968.4, 968.7], operative [285.1, 998.1, 998.11, 998.12, 998.13, E870.0, 998.3, 998.7], perioperative cardiovascular [utilizing ICD-9-CM codes 997.1, 410, 785.50, 785.51, 785.59, 998.0, 453.4, 453.8, 453.9, 415.1, 415.11, 415.19] and perioperative pulmonary complications [utilizing ICD-9-CM codes 997.3, 518.81, 518.4, 518.5, 512.1, 31.1, 31.2, 31.29, 96.7].

Results

Acute post hemorrhagic anemia (1.45%, ICD-9-CM 285.1) was the most common operative complication. Cardiac arrest and cardiorespiratory failure resulting from the procedure (0.83%)and iatrogenic pulmonary embolism and infarction (0.15%) were the most common cardiovascular complications.

Pulmonary insufficiency following trauma and surgery (1.36%, ICD-9-CM 518.5), acute respiratory failure (1.05%, ICD-9-CM 518.81), and temporary tracheostomy (0.91%, ICD-9-CM 31.1) were the most common pulmonary complications. Of the 493 resections with one or more complications, pulmonary insufficiency following trauma and surgery (16.63%) and acute respiratory failure (12.78%) were the most frequent perioperative pulmonary complications.

Discussion and Conclusion

Assessed HCUP NIS data demonstrates intraoperative hemorrhage and hematoma as a most common operative complication, cardiorespiratory failure during or resulting from a procedure as a most common perioperative cardiovascular complication, and pulmonary insufficiency as the most common perioperative pulmonary complication (2, 3). Being aware of these complications may help to create future guidelines and set up management priorities; these factors must be kept in the forefront of the anesthesiologists mind during the perioperative period(4, 5).

References
1. Andaluz N et al. Journal of Neurosurgery 2008; 108:1163-9
2. Hoh B. et al. Stroke 2010; 41:337-42.
3. Lim M. et al. Journal of Clinical Neuroscience 2006; 13:413-8.
4. Brinjikji W et al. Stroke 2011; 42:1320-4
5. Harrigan et al. Journal of Neurotrauma. February 2014, ahead of print

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