Race and Cerebrospinal Fluid Leaks: Concerning Associations after Endonasal Transsphenoidal Pituitary Resection

Ross Rosen; Claudia I. Cabrera; Daniel Karasik; John Richter; Kenneth Rodriguez; Sanjeet V. Rangarajan; Brian D'Anza

doi:10.1055/a-2505-7941

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base
DOI: 10.1055/a-2505-7941

Original Article

Race and Cerebrospinal Fluid Leaks: Concerning Associations after Endonasal Transsphenoidal Pituitary Resection

Authors

Ross Rosen

¹Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
Claudia I. Cabrera

¹Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates

²Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates
Daniel Karasik

¹Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
John Richter

¹Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates
Kenneth Rodriguez

¹Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates

²Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates
Sanjeet V. Rangarajan

¹Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates

²Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates
Brian D'Anza

¹Department of Otolaryngology—Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United Sates

²Department of Otolaryngology—Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United Sates

Abstract

Objective To identify and describe differences in the rates of cerebrospinal fluid (CSF) leaks after transsphenoidal pituitary resection (TSPR) on a demographic basis.

Design Multi-institution health care database study.

Setting TriNetX research database.

Methods The database TriNetX was searched for rates of CSF leaks after TSPR. Patients were excluded if they had a CSF leak diagnosed any time prior to postoperative day number one. Demographic factors such as sex and race were compared in cohorts matched by other demographic characteristics, obstructive sleep apnea, body mass index categories, functional adenoma status, nicotine use, and concurrent lumbar drain placement.

Results A total of 8,741 patients were included in the analysis, with a total rate of postoperative CSF leak of 2.62%. After matching, race and sex were both significant risk factors for CSF leak, with Black patients having a higher risk when compared with White patients (risk ratio [RR]: 1.68, 95% confidence interval [CI]: 1.08–2.60) and females having a higher risk compared with males (RR: 1.33, 95% CI: 1.00–1.77).

Conclusion Even when matching for obstructive sleep apnea, weight, functional adenoma status, nicotine use, and concurrent lumbar drain placement, Black and female patients had higher rates of CSF leaks in the month following surgery. This finding highlights an important gap in the literature that should be addressed through future prospective studies and the need to better understand potential demographic disparities in health care.

Keywords

disparities - health inequity - pituitary adenoma - transsphenoidal - skull base surgery - postoperative outcomes - diversity - equity and inclusion

Full Text

References

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