2026 Proffered Presentations
S255: IMPACT OF OVERWEIGHT AND OBESITY ON OUTCOMES FOLLOWING ENDOSCOPIC TRANSSPHENOIDAL SURGERY FOR PITUITARY ADENOMAS: AN INTERNATIONAL MULTICENTER DATABASE STUDY
Niraj Rama, BS1; Rahim Abo Kasem, MD1; Philip Ostrov, MD1; Maunil Mullick, BS1; Arshi Kaur, BS, MS1; Charles Froman-Glover, BS1; Isaac J Abecassis, MD1; Norberto Andaluz, MD2; Dale Ding, MD1; Akshitkumar Mistry, MD1; Brian J Williams, MD1; 1University of Louisville School of Medicine; 2University of Cincinnati
Background: The prevalence of obesity continues to rise worldwide, contributing to increased surgical complexity and adverse outcomes across multiple specialties. Prior studies have found higher risks of infection, readmission, and complication rates in obese patients, along with challenges related to anesthesia and perioperative management. Endoscopic transsphenoidal surgery remains the preferred treatment for pituitary adenomas, with surgical success often judged by rates of cerebrospinal fluid (CSF) leak, postoperative endocrine function, and the need for re-intervention. Obesity may alter CSF physiology, impair healing, and exacerbate metabolic comorbidities, yet evidence directly addressing its impact in pituitary surgery outcomes is limited. This study evaluates the influence of overweight and obesity body mass index on outcomes following endoscopic transsphenoidal surgery for pituitary adenomas using data from an international multicenter database.
Methods: A total of 11,376 adult patients undergoing primary endoscopic transsphenoidal resection for benign pituitary tumors were identified from the TriNetX Global Collaborative Network between January 2011 and January 2025. After excluding prior craniotomy cases (n = 189), patients were stratified into overweight/obese (n = 5,070) and non-overweight (n = 6,306) groups (Fig.1). Propensity score matching (PSM) (1:1) was performed between overweight/obese and non-overweight patients using a greedy nearest-neighbor algorithm with a caliper of 0.1 pooled SMDs which yielded 4,382 patients in each cohort for adjusted comparisons (Fig. 2).
Results: The overweight/obese group exhibited significantly increased odds of postoperative cerebrospinal fluid (CSF) leak (OR 1.63, 95% CI 1.39–1.91, p<0.001), 30-day hospital readmission (OR 1.13, 95% CI 1.02–1.24, p=0.02), new-onset hypopituitarism (OR 1.30, 95% CI 1.14–1.49, p<0.001), and sexual/reproductive health issues (OR 1.54, 95% CI 1.37–1.72, p<0.001). Conversely, they had significantly lower odds of postoperative improvement in pituitary function (OR 0.79, 95% CI 0.72–0.88, p<0.001). For long-term outcomes, Ooverweight/obese patients were more likely to require re-operation beyond 30 days (OR 1.40, 95% CI 1.14–1.73, p<0.001),. For long-term outcomes, a finding confirmed by significant differences in reoperation-free survival curves Kaplan-Meier survival analysis were observed (log-rank p < 0.001) before and after PSM) (Fig. 3).
Conclusion: Overweight and /obesity body mass index isare associated with increased postoperative complications, impaired endocrine recovery, and higher re-operation rates after endoscopic transsphenoidal surgery for pituitary adenomas. These findings highlight the need for tailored peri/postoperative management in this population to mitigate adverse outcomes.
Figure 1. Flow diagram of patient selection from the TriNetX Global Collaborative Network.
Figure 2. Covariate balance between overweight/obese and non-overweight patients before and after propensity score matching (PSM). The Love plot (left) shows standardized mean differences of baseline characteristics, with improved balance after matching. Propensity score density plots (right) illustrate distribution differences before PSM and alignment between groups after PSM.
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Figure 3. Kaplan–Meier curves showing reoperation-free survival in overweight/obese and non-overweight patients before and after propensity score matching (PSM). Overweight/obese patients demonstrated significantly lower reoperation-free survival compared to non-overweight patients (log-rank P < 0.001 for both analyses).
