Assessing Patient-Reported Symptoms to Predict Postoperative Complications from Pituitary Surgery Using a Novel Consensus-Developed Inventory

Background: Endoscopic endonasal pituitary surgery is a safe and effective procedure that can often be discharged on the first or second post operative day. Published data suggests up to 8 to 10% of patients undergoing pituitary surgery can develop complications which require unscheduled visits, readmission, or reoperation, often in the 7 to 14 days following surgery prior to their first postoperative visit. During this time of increased risk, healthcare providers must utilize careful questioning and timely communication, often via phone or patient portals to determine if a patient is at risk of impending complications. We posit that patient reported symptoms can be utilized to build a predictive algorithm and reveal a patient's estimated risk following endoscopic endonasal pituitary surgery. Thus we utilized a validated expert consensus strategy to build a novel inventory to assess patient-report symptoms collected remotely following surgery. Methods: A modified Delphi technique was utilized to establish consensus amongst six rhinologists with high-volume endoscopic skull base surgery practices on the questions posed in the patient-reported symptom inventory. Experts initially submitted potential questions within the seven most common complication domains: “endocrinopathies,” “cerebrospinal fluid (CSF) leak,” “epistaxis,” “pain,” “infection,” “ophthalmologic/visual symptoms,” and “other.” Four rounds of voting discussion were required to achieve consensus on all questions, defined as at least five of six panel members agreeing to approve or remove a question from the final questionnaire. After each round, there was a discussion session conducted remotely. The final discussion occurred in-person. Results: Initially, 61 questions assessing patient-reported symptoms were proposed by and sent to experts for anonymous ranked voting. Agreement on the inclusion, content, and specific phrasing of each question was achieved via the ranked voting process and virtual/in-person discussion. Duplicate questions were eliminated prior to the first round of voting. After round 1, seven questions reached consensus for inclusion. In round 2, five questions reached consensus for inclusion. Round 3 was performed via an online meeting, and nine more questions reached consensus for inclusion. Finally, round 4 was performed via in-person discussion and eight questions reached consensus for inclusion. In total, 17 questions were included, with the remainder excluded by consensus due to similarity to other included questions, or because of other identified deficiencies. The distribution of included questions in the seven complication domains includes endocrine (4), CSF leak (3), epistaxis (2), pain control (2), postoperative infection (2), ophthalmologic (1), and other (3). Conclusion: Utilizing the modified Delphi consensus technique, our group developed a 17-question patient-reported symptom inventory which will be utilized to collect post-operative data on patients undergoing endoscopic pituitary surgery to further understand and potentially mitigate complications in the early postoperative period. Publication History Article published online: 01 February 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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