DOI: 10.5061/dryad.tht76hf1v
title: Association between preoperative medication lists and postoperative hospital length of stay after endoscopic transsphenoidal pituitary surgery

description: Background: Endoscopic transsphenoidal surgery is the most common
 technique for resection of pituitary adenoma. Data on factors associated
 with extended hospital stay after this surgery are limited. We aimed to
 characterize the relationship between preoperative medications and the
 risk of prolonged postoperative length of stay after this procedure.
 Methods: This single-center, retrospective cohort study included all adult
 patients scheduled for transsphenoidal pituitary surgery from July 1st,
 2016 to December 31st, 2019. Anatomical Therapeutic Chemical codes were
 used to identify patients’ preoperative medications. The primary outcome
 was prolonged postoperative hospital length of stay. Secondary outcomes
 included unplanned admission to the Intensive Care Unit, in-hospital and
 one-year mortality. We developed a descriptive logistic model that
 included preoperative medications, obesity, and age. Results: Median
 postoperative length of stay was 3 days for the 704 analyzed patients. A
 prolonged length of stay was defined as &gt; 4 days. Patients taking
 ATC-H drugs were at increased risk of prolonged length of stay (OR 1.56,
 95% CI 1.26-1.95, p&lt;0.001). No association was found between
 preoperative ATC-H medication and unplanned ICU admission or in-hospital
 mortality. Patients with multiple preoperative ATC-H medications had
 significantly higher mean LOS (5.4 ± 7.6 days) and one-year mortality
 (p&lt;0.02). Conclusions: Clinicians should be aware of the possible
 vulnerability of patients taking systemic hormones preoperatively. Future
 studies should test this medication-based approach on endoscopic
 transsphenoidal pituitary surgery populations from different hospitals and
 countries.
description: Patients’ characteristics and
 preoperative medications were collected from Cesare™, computerized
 software for preoperative anesthetic evaluation (Bow Médical, 80440 Boves,
 France). Preoperative medications were defined using the Anatomical Therapeutic
 Chemical (ATC) classification system. In the ATC classification system, the active
 substances are divided into different groups according to the organ or
 system on which they act and their therapeutic, pharmacological and
 chemical properties. Drugs are classified in groups at five different
 levels. Cesare™ associates
 each medication trade name first with its corresponding International
 Non-proprietary Name (INN), then with its ATC code according to the ATC
 Classification System using the first four digits. In our analysis, we
 used the first level of the code, which indicates the anatomical main
 group and consists of one letter. There are 14 main groups. Each
 patient's medical prescription was transformed into numerical
 variables that indicated the number of drugs in each level-1 ATC class
 that was present in the preoperative treatment. Surgical procedures were
 identified using the French classification of homogeneous patient
 groups.<sup>14</sup> This classification, as well as most of the other
 medico-economic classifications used in the rest of the world, are derived
 from the Diagnosis Related Groups (DRGs) classification system developed
 in the 1970s in the United States<sup>15</sup> and based on the classification of hospital stays
 into a deliberately limited number of groups characterized by a double
 medical and economic homogeneity. Post-operative length of stay and hospital readmission were
 obtained using the hospital electronic health record system.
 Mortality data on the system was synchronized
 with France’s National Institute of Statistics and Economic Studies
 (INSEE) database, ensuring a near-complete follow-up after hospital
 discharge. The INSEE register of death is regularly updated as
 municipalities send weekly reports of death certificates of their
 citizens. We looked at
 in-hospital mortality, defined as any death occurring during
 a hospital stay, and
 one-year mortality, defined as any death reported on the INSEE register
 within one year of surgery. Data were anonymized before entry onto a secure
 internet-based electronic case record form designed specifically for our
 study.
description: Missing values are identified as NA.