Abstract SNACC-22

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Factors predicting outcome of acromegalic patients undergoing pituitary surgery

Prabhakar H, Luthra A, Rath G, Bithal P
All India Institute of Medical Sciences, New Delhi, Delhi, India

Introduction
Anaesthetic implication of acromegalic patients is particularly important in terms of changes in the upper airway and increased chances of pulmonary and cardiovascular complications.
Aim
The aim of our study is to determine factors affecting outcome of acromegalic patients undergoing surgery for pituitary tumors. The primary outcome was condition at discharge, intensive care unit (ICU) and hospital stay.
Methods
For this retrospective study, data were collected from the records of all acromegalic patients undergoing pituitary surgery during the period from January 2005 to December 2012. Demographics, type of surgery, size of the pituitary tumor, preoperative investigations and intraoperative data like blood loss, duration of anaesthesia and surgery and perioperative complications were noted. Data were also collected for postoperative recovery profile, duration of mechanical ventilation, intensive care unit and hospital stay. The Glasgow coma scale and outcome scale at discharge were recorded. Data are presented as Mean (SD), Median (Range) or number (%).
Results
One hundred and twenty nine acromegalic patients were operated for pituitary surgeries during the study period. The demographic [Table 1],perioperative data and complications [Tables 2, 3]are tabulated. The size of tumor (p = 0.03; ρ = 0.18), intraoperative blood loss (p< 0.00001; ρ = 0.5), intraoperative complications (p = 0.002; ρ = 0.26), duration of surgery (p < 0.00001; ρ = 0.36) and anaesthesia (p = 0.0001; ρ = 0.34), total fentanyl consumption (p = 0.01; ρ = 0.23) and duration of mechanical ventilation (p < 0.00001; ρ = 0.5) affected the ICU stay; while duration of symptoms (p = 0.02; ρ = 0.2), size of the tumor (p = 0.01; ρ = 0.22), duration of surgery (p = 0.008; ρ = 0.23) and anaesthesia (p = 0.005; ρ = 0.24) and duration of ventilation (p = 0.003; ρ = 0.31) affected the total hospital stay. There was mortality in 3 patients (2.3 %) while 7 patients (5.4 %) had moderate disability (diminution of vision) at discharge while 119 (92.2 %) patients showed good recovery.
Conclusion: The size of tumor, duration of symptoms, duration of surgery and anesthesia and duration of mechanical ventilation is associated with prolonged ICU and hospital stay in acromegalic patients undergoing pituitary surgery.

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