• Michael Karsy, Christian A Bowers, Jonathan Scoville, Bornali Kundu, Mohammed A Azab, J Michael Gee, Jian Guan, and William T Couldwell.
• Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
• Neurosurgery. 2019 May 1; 84 (5): 1104-1111.

BackgroundPituitary adenomas are among the most common primary brain tumors. Recently, overlapping surgery has been curbed in many institutions because of the suggestion there might be more significant adverse events, despite several studies showing that complication rates are equivalent.ObjectiveTo assess complications and costs associated with overlapping surgery during the transsphenoidal resection of pituitary adenomas.MethodsA single-center, retrospective cohort study was performed to evaluate the cases of patients who underwent a transsphenoidal approach for pituitary tumor resection. Patient, surgical, complication, and cost (value-driven outcome) variables were analyzed.ResultsA total of 629 patients (302 nonoverlapping, 327 overlapping cases) were identified. No significant differences in age (P = .6), sex (P = .5), tumor type (P = .5), or prior rates of pituitary adenoma resection (P = .5) were seen. Similar presenting symptoms were observed in the 2 groups, and follow-up length was comparable (P = .3). No differences in tumor sizes (P = .5), operative time (P = .4), fat/fascia use (P = .4), or cerebrospinal fluid diversion (P = .8) were seen between groups. The gross total resection rate was not significantly different (P = .9), and no difference in recurrence rate was seen (P = .4). A comparable complication rate was seen between groups (P = .6). No differences in total or subtotal costs were seen either.ConclusionThe results of this study offer additional evidence that overlapping surgery does not result in worsened complications, lengthened surgery, or increased patient cost for patients undergoing transsphenoidal resection of pituitary adenomas. Thus, studies and policy aiming to improve patient safety and cost should focus on optimizing other aspects of healthcare delivery.Copyright © 2018 by the Congress of Neurological Surgeons.

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