Postoperative screening for distress symptom cluster in patients with pituitary adenomas: a propensity-score matched...

To evaluate the efficacy of postoperative screening for distress symptom cluster in patients undergoing surgery for pituitary adenoma (PA).

Prospectively collected data of 334 patients were reviewed. Patients undergoing screening were included in screening cohort. A 1:1 propensity-score matching was applied to select controls. Primary endpoint was Patient Reported Outcomes Measurement Information System (PROMIS) scores for pain interference, fatigue and sleep disturbance at 1 month after surgery between two cohorts. Minimally important difference (MID) was set at -2. Secondary outcomes included inflammatory cytokines, cumulative incidence of hospital readmission or failure return-to-work (RTW) and European Quality of Life Five-dimension (EQ-5D) scores.

Patients in screening cohort were characterized by moderate pain with mild fatigue and sleep disturbance (14.4%), moderate sleep disturbance with mild fatigue (10.8%) and moderate fatigue (8.9%). At 1-month follow-up, mean difference in PROMIS T-scores between the screening cohort and control cohort was -4.926 (p < 0.001) for pain interference, -5.283 for fatigue (p < 0.001) and -4.475 for sleep disturbance (p = 0.038), all exceeding the MID. Compared to controls, patients undergoing screening exhibited lower levels of inflammatory cytokines (all p < 0.05), lower cumulative incidences of hospital readmission (log-rank p < 0.001) or failure RTW (log-rank p < 0.001) and greater levels of EQ-5D scores (all p < 0.05) within 6 months after surgery. Minor adverse events occurred in 7.8% of screening cases.

Screening for distress symptom cluster effectively decreased pain interference, fatigue and sleep disturbance after surgery. It also correlated with improved inflammatory status and quality of life, along with a better prognosis regarding hospital readmission or failure RTW during a 6-month follow-up.