Two-year audit of outcomes of pituitary surgery at an Australian teaching hospital

Background There is evidence that cure rates and complications are influenced by the case load in neurosurgical centres performing transsphenoidal pituitary surgery. Although Australian centres may perform relatively small numbers of these procedures, there have been few published audits of their performance. Aims To conduct an audit of surgery for pituitary tumours between 2012 and 2014 in the only public hospital neurosurgical unit in the state of Western Australia. Methods A retrospective chart review was conducted with standardised extraction of data relating to indications for surgery, tumour type, procedure and post-operative endocrinological and other outcomes. Results Of 53 patients identified, most (91%) underwent transsphenoidal surgery. Most tumours were non-functioning (71.7%) and most of these extended outside the sella turcica (86.8% versus 73.3% of functioning tumours). There was complete removal in 43.3% of patients and evidence of biochemical cure in 33.3% of functioning tumours, but readmission for further surgery was infrequent (5.7%). Persistent cerebrospinal fluid leakage, photophobia and deep venous thrombosis occurred in <4% of patients. There were no deaths. There was a relatively high rate of permanent diabetes insipidus (DI) (13.2% versus <5% in published series) while the frequency of new post-operative anterior pituitary dysfunction (11.3%) was within the range reported in the literature (3-14%). Conclusions The outcomes of pituitary surgery in this audit were largely comparable to those reported from other neurosurgical units in Australia and other countries. The increased risk of permanent post-operative DI may reflect the high proportion of non-functioning tumours with extension outside the sella turcica.