Impact of nasal septal deviation on surgical outcomes in endoscopic transsphenoidal surgery: a population-based study

Purpose: Nasal septal deviation (NSD) is a prevalent condition that may affect the surgical outcome of endoscopic transsphenoidal approach surgery (ETA) for pituitary adenomas (PA). This study aims to evaluate the effect of NSD on perioperative and neuroendocrine outcomes in patients undergoing ETA for PAs. Methods: This study is a retrospective analysis utilized the TriNetX database to evaluate the effect of NSD on perioperative and neuroendocrine outcomes in patients undergoing ETA for PAs. Propensity score matching (PSM) was performed to balance baseline characteristics between NSD and non-NSD cohorts. Outcomes were presented as odds ratios (ORs) with 95% confidence intervals (CIs), calculated using the TriNetX platform. Primary outcomes include perioperative complications and postoperative endocrinological functions. Results: A total of 9,896 patients were included in the initial cohort. After matching, 2,002 patients were included in each group. The mean age at surgery was 53.1 ± 15.8 years for the NSD group and 53.0 ± 16.0 years for the non-NSD groups (SMD: 0.006, p = 0.842). Patients in the NSD group demonstrated a higher risk of postoperative cerebrospinal fluid (CSF) leakage (OR: 2.04; 95% CI: 1.63–2.54; p < 0.001), postoperative diabetes insipidus (DI) (OR: 1.36; 95% CI: 1.18–1.57; p < 0.001), desmopressin use (OR: 1.26; 95% CI: 1.06–1.51; p = 0.009), hypopituitarism (OR:1.63; 95% CI: 1.40–1.89; p < 0.001), and steroid use (OR: 1.43; 95% CI: 1.25–1.62; p < 0.001) as compared to the non-NSD group. Sensitivity analyses confirmed consistent results across different matching models. Conclusions: These findings indicate that patients with NSD undertaking ETA for PAs had higher risks of postoperative complications, including postoperative CSF leakage, DI, desmopressin use, hypopituitarism, and steroid use.