Correlation between nasal obstruction, quality of life and costs of endoscopic vs. microscopic transsphenoidal pituitary surgery in a low/middle-income country

Abstract Few studies compare the post-operative nasal symptoms, quality of life, and costs in the microscopic vs. endoscopic transsphenoidal approaches for pituitary adenomas, particularly in low/middle-income Latin American populations. This ambispective study correlated the perception of nasal obstruction, quality of life and costs of endoscopic vs. microscopic transsphenoidal pituitary surgery at the Fundación Santa Fe de Bogotá, Colombia between January 2018, and December 2019. A total of 46 patients (mean age: 50.57 years) who underwent pituitary resection for adenomas either by microscopic or endoscopic approach in the Neurosurgery and/or Otolaryngology departments of the Fundación Santa Fe de Bogotá were included. Postoperative perception of nasal obstruction was assessed through the Nasal Obstruction Symptom Evaluation (NOSE) and a visual analog scale (VAS). Quality of life was assessed with the Glasgow Benefit Inventory (GBI). Surgical-related and hospitalization costs were extracted from the hospital’s finances database. A median difference of 45 points favoring the microscopic approach was found in the global scores of the NOSE scale. A median difference of 4 points was found in the VAS score (p<0.001 in both interventions). The GBI median scores were 27.78 points (IQR: 55.56), and 25.00 (IQR: 25) for the microscopic and endoscopic approaches, respectively. A negative correlation between the GBI and NOSE was found (ρ̂=-0.44; 95% CI: -0.684 to -0.095), implying that the less postoperative nasal obstruction, the better quality of life. The difference between median surgical-related costs was $ 437.92 USD, favoring of the microscopic approach (p=0.03). Nasal obstruction and quality of life were correlated, highlighting the impact of sinonasal outcomes in patients’ quality of life. Statistically significant differences were found in postoperative nasal obstruction symptoms and costs, favoring the microscopic approach.