2026 Poster Presentations
P213: SINONASAL MORBIDITY AND RELATED HEALTHCARE UTILIZATION FOLLOWING TRANSSPHENOIDAL HYPOPHYSECTOMY: A POPULATION-BASED COHORT STUDY
David R Hoying, MD1; Cynthia Schwartz, MD1; Raj Sindwani, MD2; 1Kirk Kerkorian School of Medicine at UNLV; 2Cleveland Clinic
Background: Previous research on the sinonasal morbidity of transsphenoidal hypophysectomy (TSH) and healthcare utilization after surgery has been limited.
Objective: We evaluated the incidence of sinonasal procedures, healthcare utilization, and the development of chronic rhinosinusitis (CRS) and sinonasal symptoms up to 5 years after TSH using a large population-based database.
Methods: We conducted a retrospective cohort study using the TriNetX platform to identify patients who underwent TSH via an intranasal approach. Outcomes included sinonasal procedures—turbinate reduction, septoplasty, endoscopic sinus surgery, balloon sinus dilation, and lysis of intranasal adhesions—at 1 and 5-year follow-up. Patients with a prior history of the specific sinonasal procedure under evaluation were excluded. Outcomes assessed included the development of new-onset CRS at 1- and 5-year follow-up, as well as sinonasal symptoms (smell dysfunction, congestion, epistaxis, and postnasal drainage) within 1 year postoperatively. In addition, we evaluated sinonasal-related healthcare utilization within 90 days, including corticosteroid and antibiotic prescriptions, emergency department visits, nasal endoscopies, and nasal debridement.
Results: A total of 20,316 patients underwent TSH between September 2005 and September 2025. The mean age was 51.5 years (SD = 17.7), and 51% were female. 20% of the benign pituitary tumors resected were hyperfunctioning. The cumulative risk of sinonasal procedures was 0.96% at 1 year and nearly doubled to 1.8% at 5 years. By 3 years post-TSH, most procedures had already occurred, with a cumulative risk of 1.6%. The most common procedure performed at the one-year (0.6%) and five-year (1.2%) follow-up periods was endoscopic sinus surgery. No cases of balloon sinus dilation were recorded for either time period. Within 1 year of TSH, the incidence of new-onset CRS was 14% and smell dysfunction was 1.13%. During the same period, congestion occurred in 3.9% of patients, epistaxis in 4.2%, and postnasal drainage in 1.7%. At 5 years post-TSH, the risk of new-onset CRS was 18%, representing only a modest 4% increase compared to the 1-year risk. Within 90 days of TSH, 72% received systemic corticosteroids, 23% received antibiotics, 14% required an emergency room visit, 22% underwent nasal endoscopy (Mean: 1.35; SD: 0.64), and 25% underwent nasal debridement (Mean: 1.69, SD: 0.86).
Conclusion: The need for sinonasal procedures after TSH was approximately 2%, indicating that a small proportion of patients required postoperative intervention. However, despite the lower rate of procedures, nearly 20% of patients developed new-onset CRS within 5 years. New-onset smell dysfunction persisted in over 1% of patients following TSH at 1 year. Sinonasal-related healthcare utilization was common, with a high proportion requiring postoperative corticosteroids, antibiotics, debridements, and endoscopies. Overall, there appears to be an association with sinonasal morbidity and TSH; however, while many patients are diagnosed with CRS, only a small percentage ultimately require a sinonasal procedure after TSH.