2026 Proffered Presentations
S186: UPDATE ON CONTEMPORARY TRENDS IN PEDIATRIC PITUITARY SURGERY: A NATIONAL ANALYSIS OF APPROACHES AND COMPLICATIONS
Viraj Shah, MD1; Aayush Shah, BS2; Madison Buras, MD1; Sei Chung, MD1; 1University of Texas at southwestern; 2University of Florida
Objective: This study analyzes the characteristics and complications associated with modern pediatric pituitary resection using a national pediatric inpatient database. We compare patient demographics, hospital outcomes, and post-operative complications between transsphenoidal and open surgical approaches for pituitary resection.
Methods: We conducted a retrospective cohort study using the 2022 Kids' Inpatient Database (KID). Patients aged 20 years or younger who underwent pituitary surgery were identified using ICD-10-PCS procedure codes for transsphenoidal (TS) and transcranial (TC) resection. Post-operative complications were identified by diagnosis codes recorded during the surgical hospitalization. All analyses were performed using a complex survey design to generate nationally representative estimates.
Results: An estimated 295 pediatric pituitary surgeries were performed in the U.S. in 2022. Pituitary adenoma was the most frequent pre-operative diagnosis, accounting for 64% of cases, followed by craniopharyngioma (15%) and meningioma (1.0%). The TS approach was the most common, constituting 72.4% of all procedures, compared to 27.1% for the TC approach. Significant differences were found in median length of stay (3.0 days for TS vs. 4.0 days for TC, p<0.001) and total hospital cost ($34,479 for TS vs. 31,748 for TC (p<0.001) between approaches. The most frequent overall complications were diabetes insipidus (37%), visual changes (24%), and panhypopituitarism (23%). Rates of CSF leak (14% for TS vs. 12% for TC) (p=0.033) and hydrocephalus (6.3% TS vs. 5.1% TC) (p<0.001) differed significantly by surgical approach. In a sub-analysis of the transsphenoidal group, panhypopituitarism was significantly more prevalent in males than females (32% vs. 14%, p=0.010). Patients aged 10 years or younger had significantly higher rates of diabetes insipidus (75% vs. 30%, p<0.001), panhypopituitarism (44% vs. 19%, p=0.033), and hydrocephalus (19% vs. 4.9%, p=0.035) compared to older children.
Conclusion: The transsphenoidal approach remains the predominant surgical modality for pediatric pituitary resection. Post-operative complication profiles differ significantly not only by surgical approach but also by patient age and sex. Younger patients demonstrate a higher risk for several key complications. These findings provide updated, nationally representative benchmarks that can inform surgical planning and patient counseling.