2026 Proffered Presentations
S253: POST-OPERATIVE DAY ONE GLUCOSE LEVELS INCREASE ODDS OF EXTENDED HOSPITALIZATION - A SINGLE-CENTER RETROSPECTIVE ANALYSIS OF 354 PATIENTS FOLLOWING PITUITARY SURGERY
Eric Lassiter1; Jessica Eaton, MD1; Chris Seward, MD1; Tyler Lazaro, MD1; Thomas Hanks1; Wenxuan Xiong, PhD1; Patrick Bi1; Rya Berrigan1; Jack Sedwick1; Rose Wang1; Kyle Montgomery1; Kyly Hiatt1; Ivan Brown1; Ian Humphreys, DO2; Al-Waleed Abuzeid, MD2; Aria Jafari, MD2; Brent Wisse, MD1; Manuel Ferreira, MD, PhD1; Samuel Emerson, MD, PhD1; Jacob Ruzevick, MD1; 1University of Washington Department of Neurological Surgery; 2University of Washington Department of Otolaryngology/Head and Neck Surgery
Introduction: Pituitary neuro-endocrine tumors (PitNETs) and Rathkes Cleft Cysts (RCC) comprise the majority of surgically treated sellar-based pathology. Endoscopic endonasal transsphenoidal surgery (ETSS) performed at high volume pituitary centers is typically associated with a short post-operative stay. However, select patients experience extended hospitalizations which confers greater financial and resource burden.
Objective: Identify modifiable risk factors corresponding to extended length of stay (LOS) following ETSS for PitNETs and RCCs to help inform clinical treatment plans, develop system-level pathways, and allocation of resources.
Methods: An IRB-approved, single-center retrospective cohort study of patients undergoing ETSS for resection of a PitNET or RCC between August 1, 2021, and July 31, 2024, was performed. Patient demographics, pathology, and surgical variables were collected using the electronic health records system. We employed Firth’s penalized logistic regression to evaluate demographic, surgical, endocrinologic variables associated with a LOS >36 hours, the outcome of interest.
Results: A total of 354 patients (94% PitNET, 6% RCC) were included for study. A total of 197 patients were female (56%). A total of 18% had a known preoperative diagnosis of diabetes mellitus and the mean BMI at time of surgery was 31 ± 7. A total of 159 patients (45%) had a LOS >36 hours. Of the variables assessed, the odds for a LOS >36 hours were significantly increased in the setting of an intraoperative cerebrospinal fluid (CSF) leak (OR 2.82, 95% CI 1.51–5.28, p=0.001), postoperative diabetes insipidus (OR 3.13, 95% CI 1.65–6.05, p<0.001), temporary CSF diversion (OR 8.96, 95% CI 2.66–46.59, p<0.001), longer case duration (OR 1.01, 95% CI 1.00–1.01, p = 0.006), operative start times beyond 2pm (OR 2.18, 95% CI 1.08–4.45, p = 0.031), and frequency of POD1 glucose values >180 mg/dL (OR 1.53, 95% CI 1.06–2.51, p = 0.020). Male sex was the only factor to decrease the odds of a LOS >36 hours (OR 0.50, 95% CI 0.28–0.89, p = 0.019). Each decreased LOS day conferred a hospital revenue savings of $1934.38.
Conclusion: The frequency of blood glucose >180 mg/mL during POD1 represents a modifiable risk factor for a LOS >36 hours. Additional pre-operative consultation for diabetic patients, especially those with poor serum glucose control can inform intraoperative and postoperative management of serum glucose, which may lessen the burdens of extended hospitalization.
Fig. 1: Forest Plot of Adjusted Odds Ratios
(Left) Rows represent variables in our Firth’s bias-reduced logistic regression. Estimated odds ratios (OR) are represented as diamonds with respective horizontal confidence intervals (CI). The vertical dashed line at OR = 1 indicates no association. Variables with CI that do not cross OR = 1 were deemed statistically significant and depicted with asterisks. (Right) Corresponding variable’s OR and 95% CI values.
BMI: body mass index; CSF: cerebrospinal fluid; DI: diabetes insipidus; GLU: glucose; LOS: length of stay; NF: nonfunctioning; POD0/1: postoperative day 0/1; RCC: Rathke’s cleft cyst