Abstract

Introduction: Acromegaly is a chronic, insidious, debilitating disease, which occurs due to chromophobe adenoma of the pituitary resulting in excessive secretion of growth hormone in an adult. Anaesthetic implication of this disorder is particularly important in terms of changes in the upper airway and increased chances of pulmonary and cardiovascular complications.

Aim: The aim of our study was to determine factors predicting the outcome of acromegalic patients undergoing pituitary surgery in terms of duration of intensive care unit (ICU) and hospital stay.

Methods: For this retrospective study, data were collected from the records of all patients undergoing pituitary surgery for acromegaly during the period from January 2005 to December 2012 at AIIMS New Delhi. Demographics, type of surgery, size of the pituitary tumor, preoperative investigations and intraoperative data like blood loss, duration of anaesthesia and surgery and perioperative complications were noted. Data were also collected for postoperative recovery profile, duration of mechanical ventilation, intensive care unit and hospital stay. The Glasgow coma scale and outcome scale at discharge were recorded.

Statistical Analysis: Data are presented as Mean (SD), Median (Range) or number (%). Continuous variables were analysed using Wilcoxon rank-sum test whereas categorical variables were subjected to Pearson’s Chi square tests. Statistical dependence between two variables was calculated using Spearman’s rank correlation test.

Results: One hundred and twenty-nine patients that were operated for pituitary tumours causing acromegaly during the study period were included. The size of tumour, intraoperative blood loss, intraoperative complications, duration of surgery and anaesthesia, total fentanyl consumption and duration of postoperative mechanical ventilation affected the ICU stay whereas the duration of symptoms, size of the tumour, duration of surgery and anaesthesia and the duration of postoperative mechanical ventilation affected the total hospital stay. There was mortality in 3 patients (2.3 %) while 7 patients (5.4 %) had moderate disability (diminution of vision) at discharge while 119 (92.2 %) patients showed good recovery. Postoperative complications were significantly associated with prolonged ICU stay and hospital stay. (p = 0.001 and 0.002, respectively).