A Prospective Study of Patient-Reported Quality of Life Outcomes in Standard and Expanded Endoscopic Endonasal Skull Base Surgery at a Tertiary Center

ABSTRACT

Introduction: Transient alterations in patient's quality of life (QOL) following endoscopic endonasal approach skull base surgery (EEA) are inevitable despite substantial progress in techniques and equipment over the last two decades. We have prospectively evaluated patient-reported QOL at our institution using multiple metrics, to better understand the sensitivity of such testing and evaluate for risk factors for worsened quality of life after EEA. Method(s) Prospective, review-board-approved, single-institution cohort study of patients undergoing EEA surgery between 2019 and 2022 (enrollment was paused March to September 2020 due to COVID-19 research restrictions). Patient-reported global PROMIS-29 and sinonasal-specific ASK-Nasal 12 metrics were obtained prior to and at routine intervals after EEA. Result(s) We enrolled 90 patients with baseline and follow-up data available. Average age was 50 years and there was a 5832 femalemale predominance. Most procedures involved at least transsellar (N = 73) surgery, although numerous expanded anatomic compartments (total N = 61) were also accessed. Pituitary adenoma was the most common pathology treated, although a wide range of others were represented. PROMIS-29 evaluation of global QOL demonstrated an expected worsening in symptoms within physical function (+2.9), social interaction (+1.1), and pain (+0.4) metrics at 2-weeks postoperatively compared with baseline;averages in these domains returned to baseline or were improved by 6 months. Anxiety and depression symptom domains were immediately improved as early as 2-weeks after surgery (-1.2 and -0.8, respectively), remaining improved compared with baseline 6 months after surgery. Sinonasal-specific QOL demonstrated expected worsening at 2 weeks postoperative (average sum ASK-Nasal 12 score 21, versus 9.7 baseline, p < 0.05) but returned to baseline at 6 months (average 9.2, p = NS). Subgroup analysis revealed that patients with functional pituitary adenoma (FPA) reported worse baseline global QOL in every PROMIS-29 domain, but similar baseline sinonasal-specific QOL, when compared with the entire cohort. FPA patients reported more absolute improvement in every domain of PROMIS-29 global QOL than did the cohort average at 6 months post-surgery (average change across all PROMIS-29 symptom domains at 6 months -1.96 for FPA, versus -1.2 for all patients, p < 0.05). Discussion(s) We prospectively assessed patient-reported global and sinonasal-specific QOL after EEA at a tertiary center using modern techniques. The PROMIS-29 global QOL metric has not been previously utilized in this patient group;expected postoperative alterations in physical and social function and pain were found and these resolved within six months of surgery. Patient symptoms in Anxiety and Depression QOL domains immediately improved at two weeks postoperatively despite objectively worse reported sinonasal QOL in the same time interval;this implies patients are strongly relieved to have completed surgery even if still suffering sinonasal QOL alterations in the early perioperative period. Patients with functional pituitary tumors have, not surprisingly, worse baseline global QOL than do average EEA patients;nevertheless, functional tumor patients also show more absolute improvement in QOL after surgery. (Figure Presented).