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

World Neurosurg. Mar-Apr 2014;81(3-4):576-83. doi: 10.1016/j.wneu.2013.11.014. Epub 2013 Nov 13.

Abstract

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

Methods: Our multidisciplinary 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, maximum 4.5 cm, 18% microadenomas). Endoscopic endonasal surgery characterized by aggressive tumor resection and avoidance of nasal packing and lumbar drains was used in all cases. Lengths of stay, readmissions, and postoperative outcomes were analyzed.

Results: Using the short-stay protocol, 92% (46 of 50) of patients were successfully discharged on postoperative day 1. The average length of stay for all patients was 1.16 ± 0.55 days (range 1 to 4). Postoperative diabetes insipidus occurred in 16% of patients (8 of 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 cerebrospinal fluid leak.

Conclusions: A short-stay protocol allows for an overnight hospital stay for patients after pituitary surgery, with a low rate of complications or readmission. This study offers evidence-based guidelines that may be used to avoid complications and facilitate early discharge after transsphenoidal surgery.

Keywords: Adenoma; Endoscopic surgery; Pituitary.

Publication types

  • Clinical Trial

MeSH terms

  • Adenoma / surgery*
  • Adult
  • Ambulatory Care / standards
  • Ambulatory Care / statistics & numerical data
  • Cerebrospinal Fluid Leak
  • Cerebrospinal Fluid Rhinorrhea / etiology
  • Evidence-Based Medicine
  • Female
  • Hemorrhage / etiology
  • Humans
  • Hyponatremia / etiology
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Neuroendoscopy / adverse effects
  • Neuroendoscopy / statistics & numerical data*
  • Nose / surgery
  • Perioperative Care / standards
  • Perioperative Care / statistics & numerical data*
  • Pituitary Neoplasms / surgery*
  • Practice Guidelines as Topic
  • Prospective Studies
  • Sphenoid Sinus / surgery
  • Treatment Outcome