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  • Prospective trial of a short hospital stay protocol after endoscopic endonasal pituitary adenoma surgery

    Final Number:
    1339

    Authors:
    Jonathan G. Thomas MD; Nisha Gadgil; Susan Samson; Masayoshi Takashima; Daniel Yoshor MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Patients typically remain hospitalized for several days after transsphenoidal surgery for pituitary adenoma resection for reasons including pain control, serial neurological assessments, surveillance for CSF leak, and management of endocrine issues. We sought to determine if an evidence-based perioperative care protocol combined with an endoscopic approach could lead to routine and safe discharge on post-operative day 1 (POD1).

    Methods: Our multi-disciplinary pituitary group prospectively implemented a perioperative care protocol that emphasizes patient education, early mobilization, and scheduled inpatient and outpatient endocrine assessments on 50 consecutive patients who underwent surgical resection of a pituitary adenoma (82% macroadenomas, 2.1±0.8 cm, max 4.5 cm, 18% microadenomas). Endoscopic endonasal surgery characterized by aggressive tumor resection and avoidance of nasal packing and lumbar drains was employed in all cases. Lengths-of-stay, readmissions, and postoperative outcomes were analyzed.

    Results: Using the short-stay-protocol, 92% (46/50) of patients were successfully discharged on POD1. The average length-of-stay for all patients was 1.16 ±0.55 days (range 1-4). Postoperative diabetes insipidus (DI) occurred in 16% of patients (8/50), was effectively managed on an outpatient basis and did not delay discharge. Readmission was required in 2 patients, in both cases for delayed presentation of a CSF leak.

    Conclusions: A short-stay protocol allows for an overnight hospital stay for patients following endoscopic endonasal pituitary surgery with a low rate of complications or readmission.

    Patient Care: We show that our perioperative protocol after transsphenoidal surgery safely and effectively allows for early mobilization and short length-of-stay.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe post-operative care concerns in patients who have undergone transsphenoidal pituitary surgery, 2) Understand how most postoperative endocrinologic disorders can be safely managed as an outpatient.

    References:

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