(1213) Endoscopic Transsphenoidal Pituitary Resection Is Safe in Older Patients: An International Database Study

Introduction: Endoscopic transsphenoidal surgery (ETS) for pituitary adenoma (PA) resection is a safe procedure, but risk factors for elderly patients have only been investigated in single center studies. As elderly patients have increased comorbidities, understanding the difference in ETS outcomes is essential to improve their care. To our knowledge, this is the largest study to date to assess surgical outcomes in elderly patients following ETS.

Methods: The TriNetX database from 2000–2023 was queried for elderly (65 years or older) and adults (18-65 years) that received ETS. Demographic data and comorbidities were compared. Cohorts were matched and endocrinopathies and complications were compared for 5 years following ETS.

Results: A total of 3,424 patients age 65 or older and 5,119 patients under 65 were analyzed. Elderly patients had higher rates of all comorbidities than younger patients (p < 0.0001). However, no significant difference in odds ratios between elderly and younger patients for CSF leak, SIADH, pulmonary embolism, steroid use and hypothyroidism at 1 month, 3 months, 6 months, 1 year, 3 years, and 5 years after ETS was noted. Younger patients had significantly higher odds of testosterone replacement (OR:0.652 p = 0.0002; OR: 0.712 p < 0.0001) and diabetes insipidus (OR: 0.606 p < 0.0001; OR: 0.593 p < 0.0001) than older patients at 3 months and 5 years respectively. This relationship persisted at all measured time points. There was no significant difference in 30 and 90-day readmission rates between the 2 cohorts.

Conclusions: The prevalence of endocrinopathies and complications after ETS did not differ between elderly and younger patients despite elderly patients having higher rates of preoperative comorbidities. Younger patients were more likely to experience diabetes insipidus and hypogonadism than older patients. ETS for PAs is a safe and optimal treatment for well-selected patients, regardless of age.